Christ Episcopal Church Community Support Committee Grant Request Form A) ORGANIZATION SEEKING FUNDING Name: Address: City: State: Zip: Phone: Web site: Contact Person: Title: E-Mail: B) PROJECT / PROGRAM TITLE: ________________________________________________________ Project / Program date or time frame ___________________________________________________________ C) PROPOSAL INFORMATION Please provide here or attach: Population to be served (e.g., senior citizens): Number of individuals to be served: Geographic area to be served: D) BUDGET INFORMATION Grant amount requested: $_________________ Funds are needed for: Capital _________ General Operating support ________ Start-up costs __________ Project/program support ______ Other (explain) _______________________________________________ Total Budget for this Project/Program: $ Funds available to date: $ Balance to be raised: $ Primary source(s) of current and future funding: Long term strategy (if applicable) for sustaining project/program funding: See grant application guidelines here: http://bit.ly/2zqGiqY

cec-grant-application-form.pdfPlease email this application to Deacon Eric Johnson at [email protected]:

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Page 1: See grant application guidelines here: …christchurchanacortes.org/.../cec-grant-application-form.pdfPlease email this application to Deacon Eric Johnson at AnacortesEric@gmail.com:

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

Page 2: See grant application guidelines here: …christchurchanacortes.org/.../cec-grant-application-form.pdfPlease email this application to Deacon Eric Johnson at AnacortesEric@gmail.com:

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.