APPLICATION FOR AAHI & CDP CAPACITY BUILDING SUPPORT

AAHI GRANT WRITING SUPPORT REQUEST FORM

Please complete the following form to be considered for free grant writing courses and consultation for the upcoming Healthy Communities Fund grant cycle. This free package has a $280 value.
ORGANIZATION NAME
ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
PHONE
WEBSITE
ANNUAL BUDGETED REVENUE
NUMBER OF PAID STAFF
NUMBER OF VOLUNTEER/ UNPAID STAFF
CONTACT INFORMATION

First NameLast Name
TITLE
E-MAIL
example@example.com
PLEASE VERIFY THE FOLLOWING STATEMENTS ARE TRUE BY CHECKING THE BOX.
Organization is a nonprofit corporation with either 501(c)(3) or 501(c)(4) tax-exempt status.

TRUEFALSE
Organization is Asian American Pacific Islander (AAPI) led serving Montgomery County, Maryland or organization is serving AAPI residents in Montgomery County Maryland.

TRUEFALSE
Organization has been continuously delivering culturally and linguistically competent services to AAPI communities in Montgomery County Maryland since July 1, 2021.

TRUEFALSE
Nonprofit is registered and is in good standing with the State of Maryland or adjacent jurisdiction.

TRUEFALSE
PLEASE PROVIDE A STATEMENT OF NEED FOR GRANT WRITING TRAINING AND CONSULTATION AS WELL AS THE IMPACT YOU HOPE TO GAIN FROM THIS CAPACITY BUILDING OPPORTUNITY.
Should be Empty:

AAHI GRANT WRITING SUPPORT REQUEST FORM