Community Service Grant Application

Section 1: Applicant Information

1.1 Organization Name:

1.2 Organization Address

Street Address Line 1 Street Address Line 2 City State

1.3 Contact Information:

Primary Contact Name: Position/Title: Phone Number: Email Address: 1.4 Organization’s Mission Statement:

1.5 Tax Status:

Tax Status If "Other," please specify:

Section 2: Project Information

2.1 Project Title: 2.2 Project Summary: 2.3 Target Community/Population:

2.4 Project Dates

Start Date

Day

Month

Year

End Date

Day

Month

Year

2.5 Total Project Budget: 2.6 Amount Requested from This Grant: 2.7 Project Activities: 2.8 Expected Outcomes and Impact:

Section 3: Financial Information

3.1 Detailed Budget (Please attach a detailed budget outlining project expenses and funding sources, including other grants if applicable): 3.2 Financial Statements (Attach the most recent financial statements for your organization):

Section 4: Additional Documents

4.1 Project Plan (Attach a detailed project plan, including timelines and milestones): 4.2 Letters of Support (Optional: Attach any letters of support from community leaders, stakeholders, or partners):

Section 5: Certification

I certify that the information provided in this application is true and complete to the best of my knowledge and belief. I understand that any misrepresentation may result in disqualification from the grant process.

Signature:

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Date

Day

Month

Year