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Community Television of Santa Cruz County Youth A/V Grant Form
BEFORE COMPLETING THIS APPLICATION, PLEASE READ THE MISSION STATEMENT BELOW AND THE GUIDELINES FOR APPLYING (http://www.communitytv.org/youth-av-grant-guidelines/).

Community Television's mission is to foster community dialogue and individual self-expression through television, the Internet and other electronic media.  Priority will be given to Santa Cruz County organizations serving the youth of our county which submit proposals that further the CTV mission.  Grantee must provide a minimum of one hour of content per quarter to appear on CTV channels.

NOTE:  EQUIPMENT PROVIDED BY THIS GRANT MAY NOT BE USED FOR ANY COMMERCIAL PURPOSES.

We are looking for Santa Cruz County organizations that enhance academic achievement and prepare youth and young adults for employment or higher education with skills using Digital Media tools.  Our grant program is supported by PEG funds provided for this purpose, collected from cable subscribers and administered by Santa Cruz County.  

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Application Date *
Today's Date
MM
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DD
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YYYY
Organization name *
Contact information *
 Full address, including mailing address, telephone number and website
Federal tax-exempt number *
Tax ID
Name, title, telephone number, and email address of contact person for this proposal
If different from above.
Period this funding request will cover *
Keeping in mind the mission of Community Television, describe the purpose of this funding request, including a brief description of the population and number of individuals served, and geographic area(s) that will benefit *
As applicable
Keeping in mind the mission of Community Television, describe the goals that will be met using the equipment provided by this grant. Include the programming you will upload for CTV broadcast quarterly. What is the timeline for accomplishing these results? What evidence will prove your success? *
Brief description
Signature of executive director or other authorizing official *
Retype name
Edit Equipment Requested *
Maker Edit Kits
Field Equipment Requested *
Maker Field Kits
Studio Equipment Requested  Note: The Maker Studio Kit will be provided only if: 1) target population served is at least high-school age; and, 2) the organization has adequate dedicated space to create a studio. *
Required
Mobile Sports Maker Kit  NOTE: The Sports Maker Kit will only be granted to a youth organization or school with a sports team. *
Required
Other Equipment Requested
Describe your organization's history, mission and goals *
Brief description
Describe current activities, recent accomplishments, and future plans related to this grant application. *
Brief description
Describe any significant collaborations and partnerships with other entities. *
Brief desciption
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