COVID-19 Relief Fund
Nonprofit Grant Application
Street Address Line 2
State / Province
Postal / Zip Code
Contact for Application
Organization's Board President/Chair
Board President/Chair Name
Board President/Chair Email
Briefly describe your organization's mission and services. What is the population you are serving, including geographic area served?
If awarded this grant, how will the funds be used? How long do you feel you can sustain this level of operations without additional assistance?
If awarded this grant, what is the timeline or milestone dates of how the services will be provided over the next two months?
Total Cost of Need
Please discuss other sources of funding, including whether the source is secured, anticipated, or pending.
Authorizing Signature - Executive Director/CEO
Should be Empty: