MHAP Grant Funding Request Form

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Request for Grant Funding

Application Form
Purpose

The mission of Mental Health America of Pueblo is to eliminate the stigma of mental illness and to increase access to treatment through education, advocacy, and community outreach.

About the Grant Funding Request

Requests to Mental Health America Pueblo are granted based on the impact of the request to the community at large as well as the organization requesting funds.

One-hundred percent (100%) of the funds must go directly to the program or project requesting the funds.

Mental Health America Pueblo will not accept requests for fundraising entities that collect funds to be redistributed to other organizations.

Mental Health America Pueblo prioritizes requests for 501(C)(3) organizations.

The Request for Grant Funding form must be returned via the method of your choice (USPS, email, website) to Mental Health America Pueblo at least six weeks prior to the requested funding date.

All inquiries can be made in the same manner though email is preferred for ease and accuracy.

Please see the Request for Grant Funding form for contact information.

A budget for the proposed grant may be requested. If funded, we encourage you to send a brief final report/photos detailing how the funds were used within thirty days after the project.

Please send to:

mhapueblo@gmail.com

or

Mental Health America of Pueblo

P.O. Box 1423

Pueblo, CO 81003

Thank you for supporting Mental Health America Pueblo!
Organizational Information

Fill in the requested information with attention to the mandatory questions.
Organization's Name*
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Website*
Lead Contact Name*

First NameLast Name
Lead Contact Phone Number

Area CodePhone Number
Lead Contact Email*
Describe your organization's mission*

0/250
YesNo
FEIN Number (if applicable)
Grant request amount*
What specific benefits and/or outcome to the participants will be realized?*

0/250
When do you need the requested funds?

MonthDayYear
Date
What other source(s) of funding will be used to fund this project?*

0/250
How will Mental Health America of Pueblo be recognized from this contribution?*

0/250
Signature of person making this request:
Should be Empty:

Request for Grant Funding

Organizational Information