General Grant Application

Please be sure to fill out the form completely. You can not save this form and return to work on it again. We suggest you develop your budget and answers to the questions separately and then fill out the form.

Name of Project *

Project Sponsor *

Sponsor Tax ID No *

Senate District #

House District #

Project Contact Name (this field is required)

Contact Title

Contact Phone Number

Contact Email

Project County Location *

Contact Address (this field is required)

City

State

Zip Code

Address of Project (Be as specific as possible)

City

State

Zip Code

Description of Project *

Objective of the Project *

Grant Amount Requested *

Use the fields below to explain what portions of the funds you are requested will be used in which categories. Leave the categories you will not be using blank.

Personnel

Facilities (Rental)

Services

Postage

Materials/ Supplies

Sub-Contracts

Travel

Equipment

Other (specify below)

Other Expenses (use this field to identify what your other expenses will be--only fill out if *Other box is used above)

Signature (Type Your Full Name as your signature)

Email