Impact Grant Application

Application Deadline: October 15, 2024

Organization Name

Contact Person

Phone

Address

Please provide a brief overview of your organization including mission statement, focus areas, audiences served and strategic goals.

Project Title

Grant Amount Requested

Total Project Cost

Describe proposed project (what, when, why, how and by whom)

Anticipated Population Reach

Anticipated Timeline of Project

Articulate in detail the full scope of the project and the community need being addressed. Consider this an executive summary of your proposal. Be specific and concise.

Explain how this project addresses a major community initiative.

Describe why the organization is uniquely positioned to carry out this project and its capacity to implement the proposed project.

If this project includes a formal collaboration, share information about each partner and their contributions. List the local organization's contact name, phone number and email address along with a Statement of Support document from the collaborating organization.

Statement of Support from Collaborating Organization

Upload File

Board of Directors List

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Total Annual Budget & Financial Statement

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IRS 501(c)(3) Letter of Determination

Upload File

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