2017 Grant Request Form

 

Please print out below form, fill it out, sign and date.

Please send this form and Use of Funds Report Form together as soon as possible. Thank you!

To be considered for funding, you must complete this application. The deadline must be postmarked by  Friday April 14, 2017.

Applications received after this date will not be considered.

  • Name of Organization submitting request: _____________________________
  • Amount Requested: _______________________________________________
  • Contact Person:___________________________________________________
  • Address:_________________________________________________________
  • Email:____________________________________________________________

Briefly describe the needs for which you are requesting this grant:

_________________________________________________________________________

_________________________________________________________________________

Who will benefit from this grant ?

___________________________________________________________________________  ___________________________________________________________________________

How many individuals will benefit from this grant? _______________

  • Please include a copy of the total Program Budget for this project:  Attach a separate sheet with program budget listing items separately, ie: program name, staff, supplies, utilities, etc
  • Enclose a copy of your 501c3 letter or the name of your fiscal agent.

Qualifying Participants: In order to be eligible for funding, someone from your organization must be an active participant in one of the following committee(s) and or a member of the board.

Listed below are the committees and  board.  Please add their name(s) to the participating committee/Board of Directors.

Board of directors:________________________________________

Step Out Site :____________________________________________

Recruitment:_____________________________________________

Logistics:________________________________________________

Communications:_________________________________________

Fund raising:______________________________________________

Sign:______________________________________________ Date:_________________

 

Please return to:

Annual Good Friday Walk

c/o John Lawlor

PO Box 72830

Providence, RI 02907

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