2025 Grant Application -- Committee for People with Disabilities

GRANT APPLICATION FORM
All sections of the application must be completed. If you have questions or need assistance, please contact Vivian Austin, Chairperson, Mayor’s Committee for People with Disabilities at 757.214.7931 or mcfpwd@hampton.gov.
Grant Beneficiary Information

Please fill out this section completely.
Organization's Name*
Enter the name of the organization seeking the grant.
Virginia SCC Entity ID#:*
Federal EIN#: *
Apply for an EIN here.

If you do not know your EIN, try these steps:
- Look for it on the notice the IRS issued when you applied for an EIN
- Contact the bank that has your business account
- Check with agencies where you’ve applied for state or local licenses
- Look on past business tax returns
- If you still can’t find it, call the IRS at 800-829-4933 Monday to Friday 7 a.m. - 7p.m. ET.
There is currently no lookup database available at this time
Organization's Mailing Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Business Phone Number*
Please enter a valid phone number.
Business Email:*
example@example.com
Business Website:
Contact Person
Contact's Name*

First NameMiddle NameLast NameSuffix
Contact's Phone Number*
Please enter a valid phone number.
Contact's Secondary Phone Number
Please enter a valid phone number.
Contact's Email*
example@example.com
1. Amount requested: (minimum $100 and maximum $1,500)*
2. Briefly describe the project.*

0/250
3. How will your project support and enhance the lives of people with disabilities in Hampton? Please avoid naming specific individuals in your description.
4. Briefly explain how the project aligns with the Committee’s purpose.*
5. Is the project an event?
Date of Event:

MonthDayYear
Date
Location of Event:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
6. Upload relevant files: Samples include event flyer, letters of support, cost estimates, etc.

Cancelof
Supporting information from people who work with the applicant would be appropriate. For example, If you are requesting assistance for a particular program or equipment to perform a specific job, a letter from a professional working with the individual is helpful.

Supporting documentation can also be emailed to Vivian Austin, Chairperson at mcfpwd@hampton.gov.
Please check here if you will be emailing documentation.
7. Briefly describe how the grant funds will be used without identifying the benefited individuals by name. Please be specific and include examples like venue costs, speaker fees, transportation expenses, equipment rental, food, or other needs.*
***Important*** List specific items for which you are requesting funding. Provide detailed information regarding the cost of item(s). The cost estimates from possible sources must be included with this application.
8. Is there any other information about the project that you would like to share?*
I affirm that the information in this form is true and accurate according to my knowledge.
Applicant's Name*

First NameLast Name
Title:*
Applicant Contact Number:*
Please enter a valid phone number.
Applicant Alternate Contact Number:
Please enter a valid phone number.
Applicant Email:*
example@example.com
Date of Submission*

MonthDayYear
Name

First NameLast Name
Should be Empty:

GRANT APPLICATION FORM

All sections of the application must be completed. If you have questions or need assistance, please contact Vivian Austin, Chairperson, Mayor’s Committee for People with Disabilities at 757.214.7931 or mcfpwd@hampton.gov.

Grant Beneficiary Information

Contact Person