AGSM Chapter Grant Application

American Gold Star Mothers, Inc. Chapter Grant Application

Please verify the current submission deadline before completing the application. If you have questions, please contact the Grant Committee Chairman at AGSMGrants@AmericanGoldStarMothers.org. (The $400 Grant MUST be used to support a mission-related project in your Chapter area.)
Chapter Name*
Chapter President Name*

First NameLast Name
Chapter President Email*
example@example.com
Chapter Treasurer Name*

First NameLast Name
Chapter Treasurer Email*
example@example.com
Primary Chapter Contact Phone Number*
Please enter a valid phone number.

Requested form of payment (Select One)*
If requesting a check, how should the Chapter Name appear? (This should match the name on your Chapter bank account or 501(c)3 documents.)
Mailing Address where check/gift card should be mailed*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please complete the following, for review by the Grant Committee:
Target Date for Event*

MonthDayYear
Date
What is your reason for requesting funds to help serve veterans in your area?*
What group of veterans and how many would you be directly serving?*
How many AGSM Chapter members will be involved, and what will they do? *
How will this project address the needs of veteran and/or military members? *
Please list estimated cost of activity(for example: cost per person for activity, cost for food, decorations, paper goods, etc.)*
Estimated Total Cost of the Event?*

NOTE to Chapter: Print and retain a copy of this application for your records. Your submission will be emailed to the Chapter President.
- If selected, a grant Event Follow-up Report will be mailed to you with your check and is REQUIRED to be completed within 30 days after your event.
- You will also receive the Photo/Media form to be used as you take photos of your event.
- The Photo/Media Consent form MUST be completed by guests if photographing your event is to be publicized. However, if the event is in a public space, there may be a limited expectation of privacy, but an announcement of photos should be made.
If you have questions, please contact the Grant Committee Chairman at AGSMGrants@AmericanGoldStarMothers.org
Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to an award of Grant funds, I understand that false or misleading information in my application may result in legal action.

*By entering my name in the signature box below, the Applicant acknowledges that it has the same validity and meaning as a handwritten signature and is the legally binding equivalent to a handwritten signature.
Chapter President Name*

First NameLast Name
Should be Empty:

American Gold Star Mothers, Inc. Chapter Grant Application