See grant application guidelines here:...

ChristEpiscopalChurchCommunitySupportCommittee

GrantRequestForm

A)ORGANIZATIONSEEKINGFUNDINGName:Address:City:State:Zip:Phone: Website:ContactPerson: Title: E-Mail:

B)PROJECT/PROGRAMTITLE:________________________________________________________Project/Programdateortimeframe___________________________________________________________C)PROPOSALINFORMATIONPleaseprovidehereorattach:

Populationtobeserved(e.g.,seniorcitizens):

Numberofindividualstobeserved:Geographicareatobeserved:

D)BUDGETINFORMATIONGrantamountrequested:$_________________Fundsareneededfor:Capital_________GeneralOperatingsupport________Start-upcosts__________

Project/programsupport______ Other(explain)_______________________________________________

TotalBudgetforthisProject/Program: $Fundsavailabletodate: $Balancetoberaised: $Primarysource(s)ofcurrentandfuturefunding:Longtermstrategy(ifapplicable)forsustainingproject/programfunding:

Seegrantapplicationguidelineshere:http://bit.ly/2zqGiqY

E)QUALIFYINGINFORMATIONThisorganizationis(fillinallthatapply):____PublicAgency/UnitofGovernment:

____anIRSNon-profit:EIN#____________________

___aWAStateNon-profit:UBI#_____________________

____UsingthefollowingNon-profitUmbrellaOrganization:

NameofOrganization:

Address: Phone:

EINorUBI#: ContactPerson:

F)MISSIONSTATEMENT

Pleaseprovidehereorattach:

G)PAYMENTINFORMATION(Ifyourprojectisselectedforfunding)Makecheckpayableto:Mailto:Address:

H)SUBMITTALAUTHORIZATIONNameofPersonCompletingGrantApplication:___________________________________________________

Title_____________________________ Emailand/orphone:_____________________________________

Signature(notnecessaryifemailed):________________________________DateSubmitted:____________

PleaseemailthisapplicationtoDeaconEricJohnsonatAnacortesEric@gmail.com: Or,ifyouhavenoemailcapability,mailtoChristEpiscopalChurchc/oDeaconEricJohnson,1216SeventhSt,Anacortes,WA98221

Thisformisavailableasadownloadable.PDFfileorinaMicrosoftWorddocument.docxfileatourwebsite:www.ChristChurchAnacortes.orgorbyemailfromAnacortesEric@gmail.com.