LeadUS Mentoring Program 2015-16

Good Work Fund Microgrant Application

Please tell us more about your request for funding.
Organization Name
Name of business, service club, nonprofit, etc.
Are you a Covington Chamber member?
Contact Name

Last NameFirst Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Include your phone number so we can contact you with any questionsFormat: (000) 000-0000.
Website URL
Ex: ABC Nonprofit of Covington
How much funding are you requesting?
The average grant is between $100 and $500.
Are you receiving funding from other sources?
Have you received grant funding from the Covington Chamber before?
How will the money be used? Please tell us more about your request and about your relationship to the Covington Chamber or the Covington community.
This information will help us evaluate your request. Please make it succinct but detailed enough that we have a good understanding of what this funding is for.
Is there anything else we should know about your request?
Include any details not already noted above
By signing below, I certify that I am authorized by the named organization to act on their behalf, and I understand that submitting an application does not guarantee funding.
Signature
Date

MonthDayYear
Date
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Good Work Fund Microgrant Application