GRANT
APPLICATION
Contact Information
Name of Person Applying
Name of Organization Applying
(If you are a Indivual applying and not an organization please skip to page 3)
Street Address
City
State
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code
Organization Website
Organization President / Executive Director
Title
Phone Number
E-Mail Address
Contact Person
Title
Phone Number
E-Mail Address
Back
Next
GRANT APPLICATION
Organization Information
501(c)(3)?
Yes
No
Year Established
Fiscal sponsor name
Fiscal sponsor address
Total # of Board Members
Total Organization Budget
Total # of Staff
# of Volunteers
Organizational Mission
Description of Organization
Population Served
Back
Next
GRANT APPLICATION
Proposal Request
Program / Project Name
Total Program Budget
Requested Amount
Type of Request
Capacity Building
Capital Campaign
General Operating
Multi-Year Project
Program Support
Start Up
Individual Request
Individual Medical Assistance
Multi-Year Request?
Yes
No
Geographic Area Served
If the grant is approved what would the money be used for?
Most recent grants received from this funder:
Amount (1)
Date (1)
-
Month
-
Day
Year
Date Picker Icon
Funders Name:
Amount (2)
Date (2)
-
Month
-
Day
Year
Date Picker Icon
Funders Name:
Signature
Clear
Enter the message as it's shown
*
Submit
Clear Form
Print Form
Should be Empty:
Now create your own Jotform - It's free!
Create your own Jotform