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
.
* Required
Email address
*
Your email
Date of Application
*
MM
/
DD
/
YYYY
Full Name:
*
Your answer
Student ID number:
*
Your answer
Email Address:
*
Please use one that you check regularly.
Your answer
Cell Phone Number
*
Your answer
Current Address
*
Please include your City, State, and Zip code.
Your answer
TAKE ACTION PROJECT INFORMATION
Proposed Project Name:
*
Your answer
Have You Led a Take Action Project Before?
Yes
No
Clear selection
Faculty/staff Mentor Name:
Faculty/staff mentors are now optional. If you would like
Your answer
Name of Community Partner:
*
Your answer
Organization Address:
*
Your answer
Name of Contact Person:
*
Your answer
Title of Contact Person:
*
E.g. volunteer coordinator, director, etc.
Your answer
Phone Number for Contact Person:
*
Your answer
Describe the community need your project will address:
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Your answer
Who will this project affect? How?
*
Your answer
What is your anticipated time frame for this project?
*
Your answer
What will be the end result?
*
Your answer
Please include a brief estimate of how you intend to use your budget:
*
See example below
Your answer
Example
A copy of your responses will be emailed to the address you provided.
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