2019-2020 Community Support Grant Application

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Due March 15th at 5:00pm

We are providing you this document so that you can look at what will be asked of you on the form. You can save your form and go back to it. We will not accept applications unless they are submitted through this form.

Eligibility requirements for Community Support Grantees can be found here.

Organization Information

















Grant/Program Information (Part 1)

Program Support Grants: Program Support grantees must:

  • Not be the primary service provider of a large geographic area
    • Be  nonprofits that provide services in the one of the following areas:
      • Food/General Financial Support, 
      • Mental/Behavioral Health, 
      • Medical/Dental, and 
      • Shelter/Safety. 

Infrastructure Grants: Infrastructure grantees must:

  • Play a unique role in terms of overall safety net system infrastructure (i.e. that serve as the primary service organization for the state, county or region in one of the following areas; Food/General Financial Support, Mental/Behavioral Health, Medical/Dental, and Shelter/Safety)
    • Be a large nonprofit whose programs/services are:
        • Broad in scope (across multiple needs); and/or 
        • Large in scale or number of people served. 

      Funding Range:

      • Program Support Grants $5,000 - $25,000
      • Infrastructure Grants $50,000 - $100,000





        Program Information (Part 2)

        We look for organizations that have a clear theory of change. In other words, organizations who can clearly articulate how program activities, outputs, and outcomes impact their community. The following questions relate to your organization’s theory of change.






        Collaboration

        If yes, please list any partnerships or collaborations that contribute to your organization in the area below.



        Budget Information

        Please attach a program budget for the requested funds. Include all revenues and expenses applicable to this program. Budget Form



        Attachments Needed




        *If you do not have any of the above attachments, please upload a statement on letterhead explaining the reason.

        Agreements

        Your organization also must agree to the following:

        Our organization has accounting and financial reporting standards that meet the relevant Financial Accounting Standards Board (FASB) or Government Accounting Standards Board (GASB) requirements.


        Our organization complies with the USA Patriot Act.