Make a Difference Grant Application

Name *

First

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Contact Information for Applicant *

Name of Organization or School Requesting Grant: *

Type of Organization *

If a non-profit, state current status *

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.

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