SMALL GRANT APPLICATION FORM Please have all your documents and information prepared before beginning the the application. Your progress will not be saved in the event that you close your browser or time out of a session. Application Requirements can be viewed here. Please enable JavaScript in your browser to complete this form.Contact Information - Step 1 of 5Select Amount of Request: *$1-$500$501-$1,000$1,001-$1,500$1,501-$2,000$2,001-$2,500CONTACT INFORMATIONContact Name *FirstLastContact Title: *Contact Email Address *EmailConfirm EmailContact Phone Number *NextORGANIZATION INFORMATIONName of Organization: *Address of Organization *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeWebsite *Organization Tax Status: *Please Attach Copy of Tax Status Determination Letter: * Click or drag a file to this area to upload. i.e. 501(C)3 Determination LetterCommunity Served: *Organization Mission and Goals: *Organization History: *Staffing Information (Number of full time and part time employees, number of volunteers) *Description of Current Programs: *Number of Individuals served, and description of populations including age, ethnicity, age, sex socio- economic status, other relevant information *PreviousNextABOUT FUNDING REQUESTPurpose of Grant *Include activities, populations served, and needs that will be met. Collaboration with other agencies/organizations, (if applicable): Other current, prospective funding sources for program (if applicable):PreviousNextSUPPORTING DOCUMENTSPlease Attach Board of Directors List, (With Affiliations): * Click or drag a file to this area to upload. Annual Report (If Available): Click or drag a file to this area to upload. Overall Agency Operation Budget: * Click or drag a file to this area to upload. PreviousNextElectronic Signature/ Completeness and Accuracy Agreement *I AgreeBy selecting "I Agree", you are aware that your electronic signature above is the legal equivalent of your manual/handwritten signature on this Agreement. You hereby certify that the given information and materials are accurate and complete to the best of your knowledge.Please Type Your Name as Electronic Signature *Date of Signature *CommentSubmit