Emergency Food and Shelter Program Grant
Application Due Date: 5:00pm Sunday March 10, 2023
Agency Information
This application is for funding under:
*
Please Select
Phase 41: Food
Agency Legal Name
Is the applying agency a 501(c)(3)?
*
Please Select
Yes
No
EIN Number
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SAMS or UIE Number
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Congressional District of Agency
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Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Agency Principal Name
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Full Name
Title
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Additional Point of Contact
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Full Name
Title
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Agency Financials
Total Agency Operating Budget
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Requested Program Total Budget
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Amount of ESFP Funding Requested
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Brief overview of Population Served
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Most Recent Annual Audit or Financial Review
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of
Roster of the Agency's Board of Directors
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Summary of Proposal with Itemized Budget Catagories
*
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Authorizing Party
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Full Name
Title
Signature
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Date
*
-
Month
-
Day
Year
Date
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