Grant Application

Organization Information

Organization Name *

Phone *

Email *

Website *

Address

Street Address *

City *

State/Province *

ZIP / Postal Code *

Country *

First Name *

Last Name *

Job Title *

Organization Total Operating Budget

Current Year *

Past Year *

What is your current majority source of funding? *

Federal ID Number (EIN) *

Code of Incorporation *

Grant Project Information

Project Name *

Project Duration *

Project Location *

Total Amount Requested *

Date Funds Are Needed *

Nature of Request *Capitol Funding for physical assets.Project One-time service or activity.Operating Day-to-day expenses support.Program Ongoing service or activity.Endowment Long-term financial sustainability.Other Please specify nature of request.

Other *Please specify nature of request.

Please describe your program’s mission: *

Please describe your plans to use the funds: *

Documents

In order to confirm your eligibility, please submit your organization's Tax Exempt IRS letter: *

Review & Submit

Organization Information

Organization Name: {name-1}

Phone: {phone-1}

Email: {email-1}

Website: {url-1}

Address {address-1-street_address}, {address-1-city}, {address-1-state}, {address-1-zip}, {address-1-country}

Name: {name-2-first-name} {name-2-last-name}

Job Title: {text-1}

Organization Total Operating Budget: Current Year: {text-3} Past Year: {text-4}

Federal ID Number (EIN) {text-6}

Code of Incorporation {text-7}

Grant Project Information

Project Name: {text-8}

Project Duration: {text-9}

Project Location: {text-10}

Total Amount Requested: {text-11}

Date Funds Are Needed:{ date-1}

Nature of Request: {checkbox-1}

Please describe your program's mission: {textarea-1}

Please describe your plans to use the funds: {textarea-2}

Documents

Please confirm you uploaded your organization's Tax exempt IRS letter. {upload-1}

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