Community Action Grant Application
Please type your answers directly into the form. Unfortunately you cannot save your progress on the form before hitting submit so we encourage you to prepare your answers ahead of time.
I. Project Overview and Contact Information
Project Name *
Your answer
Project Location *
Your answer
Describe Project in One Sentence *
Your answer
Total Amount of Funding Requested ($) *
Your answer
Describe Project Goal in One Sentence *
Your answer
Completion Date *
MM
/
DD
/
YYYY
Name of Primary Contact Person *
Your answer
Email of Primary Contact Person *
Your answer
Phone of Primary Contact Person *
Your answer
Names of Additional Project Team Members (with email addresses) *
Your answer
Name of Organization (for organization-led projects) *
Your answer
II. Project Description
1. Please briefly describe your project (one or two paragraphs describing the major activities that will be undertaken and how that engages the community). *
Your answer
2. Which of the following goals will your project directly support? (check boxes) *
Required
2 continued. Please explain in one or two sentences how your project will support the goals you've checked above. *
Your answer
3. How will you measure the project's success? What are you trying to achieve? (How many community members will you engage, what will change in the community as a result of your project, is there something permanent for the community you are creatinvg, etc.?) *
Your answer
4. How will your project strengthen collaboration between individuals and organizations across the Western Addition neighborhood? (Will new partnerships or relationships evolve out of this project?) *
Your answer
5. What additional support might you need to successfully implement your project? *
Your answer
6. What is your timeline for this project? Dates of milestones, etc. Note: All grant expenses included in project budget must be incurred by June 30, 2020. *
Your answer
7. Are you able to complete this project with partial funding? *
8. How do you characterize the impact of this funding for your project? If possible, indicate whether this grant would be 'primary' or 'secondary'? *
Your answer
III. Project Budget
Refer to the table below to summarize your project's expenses. The total budget outlined below must equal the total dollar amount requested in this application. A maximum of $5,000 may be requested.
Budget Template
Cost of Supplies (enter $0 if not applicable) *
Your answer
Cost Description (leave blank if not applicable)
Your answer
Cost of Facilities/Space (enter $0 if not applicable) *
Your answer
Cost Description (leave blank if not applicable)
Your answer
Cost of Transportation (enter $0 if not applicable) *
Your answer
Cost Description (leave blank if not applicable)
Your answer
Cost of Contracted Labor/Honorarium (enter $0 if not applicable) *
Your answer
Cost Description (leave blank if not applicable)
Your answer
Cost of Food (enter $0 if not applicable) *
Your answer
Cost Description (leave blank if not applicable)
Your answer
Cost of Stipends (enter $0 if not applicable) *
Your answer
Cost Description (leave blank if not applicable)
Your answer
Other Costs (enter $0 if not applicable) *
Your answer
Cost Description (leave blank if not applicable)
Your answer
IV. Agreements
I agree to submit monthly email updates on the status of this project to Community Action Grant Coordinator *
Required
I agree to inform Community Action Grant Coordinator if I encounter challenges ot executing this agreement or any delays to the intended project. *
I agree to identify the Western Addition Community Action Grant award in all promotional materials and media promoting this funded project. *
Electronic Signature of Primary Contact Person (Please type your name) *
Your answer
Date *
MM
/
DD
/
YYYY
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy