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CAMS-CAIPA Community Service Fund Grant Proposal Summary of Request
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Email
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Your email
CONTACT INFORMATION
Organization's Full Legal Name
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Your answer
Mailing Address
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Your answer
City
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Your answer
State
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Your answer
Zip Code
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Your answer
Organization's President or Executive Director
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Your answer
Title
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Your answer
Phone Number
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Your answer
Email Address
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Your answer
Contact Person
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If Different
Your answer
Title
*
Your answer
Phone Number
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Your answer
E-Mail Address
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Your answer
ORGANIZATION'S INFORMATION
Is the Organization a 501 (c) 3 Not-for-Profit?
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Yes
No
Year Established
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Your answer
EIN
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Your answer
Annual Operating Budget
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Your answer
Total Number of Board Members
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Your answer
Total Number of Staff
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Your answer
Total Number of Volunteers
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Your answer
Organization's Mission Statement
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500 Characters or Less
Your answer
Brief Description of Organization
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500 Characters or Less
Your answer
Population Served
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200 Characters or Less. Please include age groups, race & ethnicity, income levels etc.
Your answer
Breakdown of Organization's Funding Sources: Current Fiscal Years
Government
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Your answer
Corporations/Foundations
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Your answer
Fees/Income Earned
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Your answer
Individual Donors
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Your answer
Other
Your answer
If "other" please specify
Your answer
Breakdown of Organization's Funding Sources: Past Fiscal Year
Government
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Your answer
Corporations/Foundations
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Your answer
Fees/Income Earned
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Your answer
Individual Donors
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Your answer
Other
Your answer
If "other" please specify
Your answer
PROPOSAL REQUEST
Program/Project Name
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Your answer
Total Program Budget
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Your answer
Requested Amount
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Your answer
Percent of Total Budget
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Your answer
Proposed Project Duration
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Project Period From
MM
/
DD
/
YYYY
Proposed Project Duration
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Project Period To
MM
/
DD
/
YYYY
Geographic Area Served
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Your answer
Purpose of Proposed Project
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1000 Characters or Less (Approximately 250 Words)
Your answer
Description of Proposed Project
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1000 Characters or Less (Approximately 250 Words)
Your answer
Are you seeking other sources of funding for this project?
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Yes
No
Have you applied to the CAMS-CAIPA Community Service Fund in the past for funding?
Yes
No
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Have you received funding from the CAMS-CAIPA Community Service Fund in the past?
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Yes
No
If yes, what years and for what projects?
Your answer
If your grant is funded in part of in whole, to whom should the check be made out to?
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Your answer
If your grant is funded in part of in whole, where should the check be remitted to?
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Your answer
How did you hear about the CAMS-CAIPA Community Service Fund?
Your answer
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I certify that the information provided on this form is true to the best of my knowledge.
Required
Submitted by
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Please type your full name
Your answer
Title
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Your answer
Email Address
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Your answer
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