Grant Application
Date
/
Month
/
Day
Year
Organization
Name of Organization
*
Address
*
City
*
State
*
Zip Code
*
Telephone Number
*
Email Address
*
Contact Person
Name of Contact Person
*
Address
*
City
*
State
*
Zip Code
*
Officers
Name
Position
Is Your Organization Non Profit?
*
Yes
No
Please state the purpose of your organization:
Amount Requested
*
Total Amount of Project
*
Specify how funds will be used who will benefit and when support is needed Use additional pages if necessary:
*
Other sources of funding for this project:
How will the effectiveness of the project be measured:
Please provide a copy of last year's financial statements. Additional information may be requested during the review process.
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Deadline to submit applications is December 31 for consideration in the following year.
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