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.
YesNo
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.
YesNoNot sure
YesNoNot sure
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.
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Good Work Fund Microgrant Application