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

Is this a non-profit

Are you a 501(c)(3)

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.Format: (000) 000-0000.

Mobile Phone

Please enter a valid phone number.Format: (000) 000-0000.

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 ($1,000 max)

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

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Financials