Community Grants Request Form Organization Name(Required) Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Website Contact Name(Required) First Last Title Contact Email(Required) Contact Phone(Please submit your request at least one month prior to the date needed.)Name / Description of Event or Activity Date of Event MM slash DD slash YYYY Date StartDate of Event MM slash DD slash YYYY Date EndAnticipated Number of ParticipantsDescription of Services Provided, Community Served and Geographic Area of ServiceAttach a flyer (if available)Accepted file types: pdf, doc, jpg, Max. file size: 100 MB.Please upload 1 page document with description.Total Project Budget(Required)Amount Requested *(Required)Federal Employer Identification Number (FEIN) (if applicable)IRS 501(c)(3) Determination LetterAccepted file types: pdf, doc, jpg, Max. file size: 100 MB.(if applicable)EmailThis field is for validation purposes and should be left unchanged.
