LARGE 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.

($2,5001 and above)

Contact Information - Step 1 of 5

Select Amount of Request: *

$2,500-$5,000
$5,001-$7,500
$7,501-$10,000
$10,001-$12,500
$12,501-$20,000

CONTACT INFORMATION

Contact Name *

First

Last

Contact Title: *

Contact Email Address *

Confirm Email

Contact Phone Number *

ORGANIZATION INFORMATION

Name of Organization: *

Address of Organization *

Address Line 1

Address Line 2

City

State

Zip Code

Website *

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 Letter

Community 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 *

ABOUT FUNDING REQUEST

Program for which funding is being requested: *

Description of program for which you are applying *

Include activities, populations served, and needs that will be met.

Goals and Objectives: *

Expected Outcomes: *

Collaboration with other agencies/organizations, (if applicable):

Other current, prospective funding sources for program (if applicable):

Upload a document describing agency trends, challenges, and accomplishments (Limit to one page): *

Click or drag a file to this area to upload.

Description of staff positions carrying out the program: *

Has agency been funded by the Trust Fund in the past? If yes, please state year, program for which you received funding, and amount received:

SUPPORTING DOCUMENTS

Please Attach Board of Directors List, (With Affiliations): *

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Annual Report (If Available):

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Most Recent Audit: *

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Overall Agency Operation Budget: *

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IRA Form 990: *

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Electronic Signature/ Completeness and Accuracy Agreement *

I Agree

By 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 *

Name

Large Grant Application Form

LARGE GRANT APPLICATION FORM

CONTACT INFORMATION

ORGANIZATION INFORMATION

ABOUT FUNDING REQUEST

SUPPORTING DOCUMENTS

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