COVID-19 Relief Grant Application Form
Organization Name
Address Location
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Contact Person Name
First Name
Last Name
Contact Person Phone
Please enter a valid phone number.
Type of Organization
What is the mission if your organization?
Please upload a copy of W-9 form
Browse Files
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Choose a file
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of
Please upload a copy of 2019 and 2020 budget
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of
Please upload an image of the location of the organization and current people working
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Choose a file
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of
Amount requested ($)
Where will you use the fund (if granted)
Total monthly expenses ($)
Total monthly income from all sources ($)
How are you helping others during the pandemic?
Was your organization affected by the pandemic?
Yes
No
What other financial relief organization you applied to?
Contact person signature
Date Signed
-
Month
-
Day
Year
Date
Submit
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