sm_outreach

Name of Organization/Agency*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Mailing Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

YesNo

Please provide your 501(c)(3) number

Contact Person Name*

First NameLast Name

Email

example@example.com

Business Phone

Please enter a valid phone number.

Mobile Phone

Please enter a valid phone number.

Organization/Agency Mission and Focus*

Geographical Area to be served with this grant: *

Specific Needs for Funding / Other information to be considered:*

What is your annual budget?*

Please provide the amount of your funding sources as a percentage for each of the following funding sources: Grants, Corporations, Institutions, Other*

Approximate Number served annually*

Amount Requested*

Completed Outreach Grant applications are reviewed 3x/yr. Deadlines for submission are April 1st, July 1st, and October 1st.

Applications can also be printed out and mailed:

Outreach Committee, St. Mary’s Church, Box 395, Barnstable, MA 02630

Please verify that you are human*

Financials