Grant Application ..................

Organization Name (required)
Please enter Organization Name

Applicant Contact Name (required)
Please enter Applicant Contact Name

Applicant Title

Phone Number (required)
Please enter Phone Number

Fax Number

Organization's E-mail (required)
Please enter E-mail Please enter a valid E-mail

Website Address

Tax Status (required)
[Ex: 501 (c)(3)] Please enter Tax Status

Please provide proof of 501(c)(3) status (pdf only) (required)
Please select Tax Status Document

Is organization a School? (required)
Yes NoPlease select one. Please select one.

Tax ID Number

Does your Organization file a 990?
YesNo

In 600 characters or less please provide a brief description of your organization and mission (required) Please enter your answer here

In 600 characters or less please list ways your organization raises funds to support its financial needs (required) Please enter your answer here

Organization Type (required) Please select an Organization Type
Choose One Public School Private School Health Charity Athletic Organization Fundraising Event Other Please specify

Organization Mailing Address (required)
Please enter Organization Mailing Address

Event/Program Name (required)
Please enter Event/Program Name

Name and Exact Date of Event/Program [Ex: Walk-a-thon Challenge on January 1st 2020] (required)
Please enter Name and Exact Date

Amount of Request (required)
$ Please enter Amount of Request

In 600 characters or less please provide details about your event/program and briefly describe how the funds are to be spent (required) Please enter your answer

If full funds are not available, will partial funding help? (required)
Yes NoPlease select one. Please select one.

In 600 characters or less please provide a list of existing contributors and additional sources of income (required) Please enter your answer

Please estimate how many people will be served by this program (required)
Please enter your answer

In 600 characters or less please provide a line item of expenses for the program/project for which you are applying [Ex: $100 T-shirts, $20 Supplies...] (required) Please enter your answer

Select the age group primarily impacted by this event/program (required)
Choose one 5-17 18-25 25-50 50+ All age groups Please select one

Select the geographical area (county) primarily impacted by this event/program (required)
Choose one Orange Osceola Lake Volusia Seminole Brevard Other Please specify Please specify County

Select the gender primarily impacted by this event/program (required)
Choose one Male Female All genders Please select one

Select the ethnic group primarily impacted by this event/program (required)
Choose one Caucasian (non-Hispanic) African American Hispanic Native American Other Please specify Please specify an ethnic group