BeSuccessful Capacity Building Rapid Response Fund Application
Thank you for your interest in the Rapid Response Fund Application! Destined for Empowerment CDC, a 501(c)(3 )organization, is pleased to invite you to apply. Please complete the form below to be considered. To learn more about the BeSuccessful Community Capacity Building Initiative please visit our website at www.be-successful.org. To learn more about our sponsoring organization, please visit www.dfecdc.org.
What is the nature of your emergency?
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Unplanned/ Unexpected Event or Situation
Time Sensitive event or situation
Unexpected Public Safety event or situation
Disaster Recovery
Other
Organization Information
Full Legal Organization Name
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Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Organization Description
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Provide detailed information on your organizations request for the rapid response funds.
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Please explain the diversity of your organizations' outreach . Check all that apply
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African- American
Hispanic / Latino American
Caucasian American
Asian American
Other
Have you received district service funds from the City Council District B office?
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Yes
No
Have you received funds from our Small Grant Application
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Yes
No
Contact Person
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First Name
Last Name
Title
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Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
E-Mail Address
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example@example.com
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Financial Information
Tax Status
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501(c)(3)
501(c)(4)
Civic Club
Super Neighborhood
Federally Recognized Tribe
Tax ID
*
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Proposal Request
Program / Project Name
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Total Program Budget
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Requested Amount
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Geographic Area Served
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Social Media
Website
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Facebook
*
Do you agree to send pictures of your rapid response efforts?
Yes
No
Do you understand that funds can not be allocated for any political events/ affiliations or support?
Yes
No
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IRS Determination Letter
*
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Completed W-9 Form
*
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Submit
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