Recovery & Community Support Initiative Request Form

Recovery & Community Support Initiative Request Form

Please fill out the form to request support. Request will be reviewed at monthly board meetings, second Tuesday of every month.
Full Name*

First NameLast Name
Email Address*
example@example.com
Organization Name*
Mailing Address (where check will be sent)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Targeted Population Served*
Project Title*
Number of people served benefiting from this grant*
Amount Requested (USD)*
Purpose of the Grant*
Date funds are needed by*

MonthDayYear
Date
By submitting this form, I certify that the information provided is accurate and that all funds received from Sand Stew Inc. will be used solely for the stated purpose.

I understand that Sand Stew Inc. reserves the right to approve, deny, or request additional information regarding any funding request. Recipients may be asked to provide proof of use, receipts, or photos for reporting purposes.
Signature*

Clear
Should be Empty: