GRANT APPLICATION
Organization Name:
*
Name of Contact Person
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Organization Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PROGRAM DESCRIPTION
Tell us a little about your program, goals & objectives, and why you seek funding.
AGE GROUPS SERVED (check all that apply)
*
Elementary (grades K-5)
Young Adult (ages 19-25)
Middle School (grades 6-8)
Adult (ages 26-64)
High School (grades 9-12)
Senior (ages 65+)
POPULATIONS SERVED (check all that apply)
*
Economically Disadvantaged
Foster or Neglected
Victims of Abuse, Crisis or Danger
Special Needs
Wheelchair
Other
Describe the specific activities for which your organization seeks funding:
*
Tell us how many people are in your program and the location(s) that you serve:
*
List your overall goals and specific objectives in which you will meet your goals:
*
Describe your long-term strategies for sustaining this program:
*
BUDGET
Describe, in detail, your specific funding needs; please include your complete program budget as well as a detailed breakdown of the project budget in which you are seeking funding:
Program Budget
*
Project Budget
*
Are you seeking funding from other corporations or non-profit foundations?
*
YES
NO
If YES above, from what organization?
Amount Requested:
*
HOW TO GET YOUR FUNDING
Make check payable to:
*
EIN | Tax ID#:
*
Please upload your organization's W9:
*
Browse Files
Cancel
of
Is the mailing address the same as above?
*
YES
NO
Mailing Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Signature:
Submit
Should be Empty: