Please enable JavaScript in your browser to complete this form.Name of Organization or School Requesting Grant: *Organization or School Website/URL *Contact Information *FirstLastContact Email *Contact Phone *Organization or School Phone *Organization or School Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeIs your Organization or School a Non-Profit 501(c)(3)? *YesNoIf you answered NO to the question above your organization or school is NOT eligible for the Make a Difference Grant (copy)Type of Organization *SchoolNon-Profit 501(c)(3)Is your Organization or School located in Lakewood, Colorado? *YesNoIf you answered NO to the question above your organization or school is NOT eligible for the Make a Difference GrantIf you are a Colorado non-profit corporation, is the organization in good standing with the Colorado Secretary of State? *YesNoIf you answered NO to the question above your organization or school is NOT eligible for the Make a Difference Grant (copy)Is the applicant a tax exempt 501(c)(3) organization? *YesNoIf you answered NO to the question above your organization or school is NOT eligible for the Make a Difference GrantIs your organization or school able to accepted ACH deposits (electronic deposits)? *YesNoIf you answered NO to the question above your organization or school is NOT eligible for the Make a Difference Grant (copy)Please upload a copy of the Organization or Schools IRS determination letter indicating 501(c)(3) tax exempt status. * Click or drag a file to this area to upload. State the organization’s mission statement: *Purpose for grant or sponsorship *Specifically, how will the funds be used? *Describe the goals and overall impact of the project or program: *How will you measure success from use of the funds? *Upload Current W9 * Click or drag a file to this area to upload. WebsiteSubmit