GRANT APPLICATION FORM

NETWORK GRANT APPLICATION FORM

Phase 1 Grants

PART A: Agency Details
Agency Name *
The registered name of your Agency
Agency Number *
Please enter the numbers that follow the letter 'A' in your agency number. Agencies in Mercer, Warren, Hunterdon and Sussex Counties: please enter 9999 here.
Agency Address *

Street Address

Street Address Line 2

City State

Zip Code
County *
Agency EIN *
Please upload your IRS Determination letter here *

Only pdf, doc, docx, jpg, png, gif file types are supported
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Contact Person Name *

First Name Last Name
Contact Person Title *
The title of the person to contact for this Application
Contact Person Phone Number *
Please enter a valid phone number.
Contact Person Email Address *
The email of the contact person
Which of these best describes your role? *

Please tell us about the need or challenge you are addressing. *

250 words maximum 0/250
Please tell us what you need to maintain, improve, or expand your operations. How will grant funds help you address the need or challenge you described above? *

250 words maximum 0/250

Project Budget

Please fill out a detailed budget for the funds you are seeking. A simple budget can be entered directly into the table below. If you have a more complicated budget or if you'd prefer, you may create your project budget in Microsoft Excel and upload it.

Budget may cover the 5-month period from January 1, 2021 - May 31, 2021.
If you are seeking support for multiple items within a category, please create your budget in Excel so you can add additional lines for each item.
Budget can include just one category or multiple categories, depending on the needs identified. It can be as simple as one line for staffing, as in the example below:

Category	Description	Cost	Observations/Details
Emergency operating funds	Pantry Assistant	$5,760	20 hours/week for 16 weeks at a rate of $18/hour

Note: most grant awards will range from $5,000 to $15,000.

Project Budget

Description
(please indicate the items/services you would like to purchase)

Cost

Observations/Details

Emergency Supplementary Food

Household & hygiene items for clients (including but not limited to baby formula, baby wipes, child or adult diapers, menstrual products, toilet paper, toiletries, soap, shampoo, and laundry detergent)

Winterization expenses (for items or services to facilitate providing food distribution and service outdoors, including but not limited to gloves, PPE, tents, heaters, outdoor lights, and snow removal)

Capacity expenses (for items or services to increase and/or improve the ability to serve neighbors in need, including but not limited to freezers, refrigerators, pallet jacks, hand trucks, shelving, electrical and/or carpentry upgrades, and vehicle purchase, rental or repair)

Emergency operating funds (including but not limited to salaries/wages, volunteer stipends, rent, and utilities)

Other

TOTAL

Please upload any supplemental files here. If you'd prefer, you may create your project budget in Microsoft Excel and upload it here.

Only pdf, doc, docx, xls, xlsx file types are supported
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Click HERE to download the budget template
Anything else we should know?
Should be Empty:

NETWORK GRANT APPLICATION FORM

The next few questions are about the food pantry.

The next few questions are about the soup kitchen.

The next few questions are about the shelter.

The next few questions are about the mobile pantry.

The next few questions are about the other food program you indicated above.