Grant Application

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
Zip Code
Organization Website
Organization President / Executive Director
Title
Phone Number
E-Mail Address
Contact Person
Title
Phone Number
E-Mail Address

GRANT APPLICATION
Organization Information
501(c)(3)?

YesNo
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

GRANT APPLICATION
Proposal Request
Program / Project Name
Total Program Budget
Requested Amount
Type of Request
Multi-Year Request?

YesNo
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)

MonthDayYear
Funders Name:
Amount (2)
Date (2)

MonthDayYear
Funders Name:
Signature

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