Date of Request

    Amount of Request

    Organization Name

    Address

    City


    State


    Zip

    Contact Name

    Phone

    Fax

    Your Email (required)

    Website

    Organization

    History of the organization

    Mission of the organization

    Organization operating budget for current fiscal year

    Summary of Request

    Document the need, problem, or opportunity to be addressed by the project

    State the goals and objectives of the project

    Provide a timeline for project development and implementation

    Estimate the number of people to be served

    Describe how outcomes will be determined

    List any project collaborators including their role

    Financial Information

    Provide a line item budget and budget narrative for the project

    Identify all other sources of funding for the project

    Required Attachments

    File types accepted are PDF, Word, Excel and TXT.
    Each individual attachment MUST NOT exceed 15MB in size, and the combined total of all attachments MUST NOT exceed 20MB.

    1. IRS tax exempt determination letter

    2. Organization current fiscal year budget

    3. Most recent audit, if available

    4. Financial statements for last three fiscal years

    5. List of Directors and Officers