GRANT APPLICATION
TIERNEY SERET CONSULTING
Contact Information
Full Legal Organization Name
Organization Website
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Organization President / Executive Director
First Name
Last Name
Title
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
E-Mail Address
example@example.com
Website
Contact Person
First Name
Last Name
Title
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
E-Mail Address
example@example.com
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Organization Information
Entity Type?
501C3
LLC
LLP
SCORP
CCORP
Other Type Non-Profit
Trust
Year Established
Total Organization Budget
Total # of Board Members
Total # of Staff
Total # of Volunteers
Organizational Executive Summary, Mission & Vision Statements
Brief Description of Organization - Why you're seeking a grant, and what you hope to achieve.
Population Served & what you hope to achieve within this served population
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Proposal Request
Program / Project Name
Projected Total Program Budget
Requested Amount
Percent of Total Budget
Type of Request
Please Select
Capacity Building
Capital Campaign
General Operating
Multi-Year Project
Program Support
Start Up
Grant Period From
-
Month
-
Day
Year
Date
Grant Period To
-
Month
-
Day
Year
Date
Multi-Year?
Yes
No
Geographic Area Served
Priority funding areas
Most recent grants received, leave blank if Not Applicable:
Amount (1)
Date (1)
-
Month
-
Day
Year
Date
Amount (2)
Date (2)
-
Month
-
Day
Year
Date
File Upload: Business Plan, Articles of Organization/Formation, EIN (IRS Form),Drivers License, SSN Card
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Silver Package
Grant Write 1 Grant Up to 200k
$1,560.00
$
1,560.00
Quantity
1
2
3
4
5
6
7
8
9
10
Bronze Package
Grant Write 1-2 Grants Up to 400k
$2,600.00
$
2,600.00
Quantity
1
2
3
4
5
6
7
8
9
10
Gold Package
Grant Write 1 Grants 400k +
$3,640.00
$
3,640.00
Quantity
1
2
3
4
5
6
7
8
9
10
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