Grant Application

Project/Grant Request Information

Project Title

If you are not requesting a Grant for a specific Project, you may enter "General Support".

Project Start Date

Total Cost of the Project

Amount Requested

Amount Raised to Date

Current Status of the Project

What community needs are met or problems are addressed by this project?

What are the project goals?

Geographic Areas Served (include specific counties)

Detailed Organization Information

Number of Staff Members

Average Tenure

Number of Board of Directors

How Often are Meetings Held?

Organization's Annual Budget

Budget for Previous 2 Years

Yearly Government Funding

Annual Operational Expenses

Major Funding Organizations and Amounts (last 3 years)

Please attach a 1-2 page summary including the purpose and history of your organization. Purpose of this funding request, to include: Community needs, target population, number of individuals who will benefit.

Agreement

By clicking submit, you are certifying to the best of your knowledge that all information included in this proposal is correct. The tax exempt status of this organization is still in effect. If a grant is awarded to this organization, then the proceeds of that grant will not be distributed or used to benefit any organization or individual supporting or engaged in unlawful activities.

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