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FALL 2020 GRANT APPLICATION
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Contact Information
Full Legal Organization Name
Street Address
City
State
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code
Organization Website
Organization President / Executive Director
Phone Number
E-Mail Address
Contact Person
Title
Phone Number
E-Mail Address
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GRANT
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APPLICATION
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Organization Information
501(c)(3)?
Yes
No
Year Established
Tax Id #
Organizational Mission Statements
Brief Description of Organization
Population Served
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GRANT
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APPLICATION
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Proposal Request
Program / Project Name
Total Program Budget
Requested Amount
Type of Request
General Operating
Multi-Year Project
Program Support
Start Up
Grant Period From
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Month
-
Day
Year
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Grant Period To
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Month
-
Day
Year
Date Picker Icon
Multi-Year?
Yes
No
Geographic Area Served (List Counties)
Priority funding areas
Have you recieved a SPG Grant in previous years? If so, when?:
Amount (1)
Date (1)
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Month
-
Day
Year
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Amount (2)
Date (2)
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Month
-
Day
Year
Date Picker Icon
If granted this award, you will be required to exhibit your program's success at the end of the grant period (Fall, 2021)
Yes, I agree to attend the SPG meeting next Fall to showcase our success and growth
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