SWOP-USA Harm Reduction Mini-Grant Request Form - 2019
This is an application. If you need any assistance completing this form, please email justice@swopusa.org.
Email address *
Are you applying for SWOP Chapter? *
Which SWOP Chapter are you applying for? If you are not applying via a Chapter, please indicate what group you are with. *
Your answer
What is your name? *
Your answer
What is your email address? *
Your answer
What is a phone number at which we can reach you? *
Your answer
List other volunteers, members, or staff who will be involved and their role:
Your answer
What type of project will you be undertaking? *
You may check more than one box
Required
When will your project start?
MM
/
DD
/
YYYY
When will your project end?
MM
/
DD
/
YYYY
What are some of the needs in your community? Why is this project important? *
Your answer
Tell us about your harm reduction project: *
Who is the lead organization? Who else is involved in planning? What are the service you will provide? Where, when and how will the project take place?
Your answer
How many people do you expect to reach on a daily/weekly/monthly basis? *
Your answer
What is the venue(s) for your harm reduction work? *
What is the desired outcome of the project? *
Your answer
What is the TOTAL dollar amount of your funding request? *
All mini-grants cannot exceed $600 disbursements, but there is the opportunity to receive multiple disbursements this year
Your answer
Where else are you receiving/requesting funding or support from? *
Your answer
How can you receive funds? *
Please indicate all options that work for you. You will be asked to confirm preferred method if funding is approved.
Required
Do you agree to report back on use of SWOP-USA funds and follow SAP tracking and evaluation protocols ? *
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Sex Workers Outreach Project. Report Abuse - Terms of Service