GRANT APPLICATION FORM

As of November 1, 2006 all grant applications must be submitted online.

This application should be submitted on-line and attachments should be e-mailed. Incomplete grant requests will not be considered. Confirmation of receipt of grant requests will follow submission.
* required fields

 
COMPLETE THE FOLLOWING: Date submitted:*
Organization Name:*
Address:*
City:*
 State:*
Zip Code:*
Phone:
Website:
Contact Person:*

 Title:*
Contact Phone:
Contact Email:*
Amount requested:
$
Duration of the project:
From:

To:
Total project budget:
$
 When are funds needed?
Number Served (this project):    
Last Year           This Year           Next Year
Brief Description of Project or Purpose for which funding is requested

Agency Information:

    
Year Established: Number of full-time employees:
General description of organization and purposes with an indication of demographics served (including numerical estimates for the last year) and principal geographic area of service:
 
Does the organization have FEDERAL tax exempt status? 
Yes No
If no, please explain:
Annual Operating Budget:
$ 		   
Has the organization had an operating deficit in the past five years: Yes No
If yes, please explain:
Has this request been authorized by the organization’s governing body? Yes No
When:

Name of president or another officer of the organization's governing body:
Name:   Title:
Application requires all information as explained in the Community Needs Grant Proposal Process.


You now have the option to print your form before submission. Please re-check your application before you print.
* required fields
Please check to see if the information is correct. If not, make any needed changes before submitting.
Please be patient once you click the submit button. Form can take time to upload, actual time will depend on your connection speed.
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