Grant Application

Submitted by webdev on Wed, 2010/06/16 - 11:57am

Have a qualified, worthwhile cause that could benefit from financial assistance?

Please fill out the form below or download a printable application for grant consideration. Required fields are marked with an *.

First Name: *

Last Name: *

Organization: *

Address: *

City: *

State: *

Zip Code: *

Phone: *

ex.(555)555-5555

Fax:

ex.(555)555-5555

Email: *

Website:

Tax ID#:

Mission of organization: *

Project Name: *

Project Summary: *

(Brief summary of project for which you are requesting funding and how this will meet the needs of the community)

County affected by project: *

(List all targeted populations)

Amount Requested: *

(How will the funds be used and what will be the measuring tool used to evaluate the project's results?)

Total project/program budget: *

(After project completion, how will the organization sustain the project/program?)

Current funding sources: *

Organization general expenses: *

Signature: *