2020-21 Merritt Take Action Application
Complete this form by April 6th to apply for a 2018-19 Merritt Take Action Grant. Please use full sentences and detailed responses for the long responses. If you have any questions, please email heh0401@westminstercollege.edu.
Email address *
Date of Application *
MM
/
DD
/
YYYY
Full Name: *
Student ID number: *
Email Address: *
Please use one that you check regularly.
Cell Phone Number *
Current Address *
Please include your City, State, and Zip code.
TAKE ACTION PROJECT INFORMATION
Proposed Project Name: *
Have You Led a Take Action Project Before?
Clear selection
Faculty/staff Mentor Name:
Faculty/staff mentors are now optional. If you would like
Name of Community Partner: *
Organization Address: *
Name of Contact Person: *
Title of Contact Person: *
E.g. volunteer coordinator, director, etc.
Phone Number for Contact Person: *
Describe the community need your project will address: *
Who will this project affect? How? *
What is your anticipated time frame for this project? *
What will be the end result? *
Please include a brief estimate of how you intend to use your budget: *
See example below
Example
A copy of your responses will be emailed to the address you provided.
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