Funding Application Form

Funding Application Form
Provide your agency and leadership details, mission, board information, and funding-related updates.
Name of Person Submitting Application
First NameLast Name
Email of Person Submitting Application
example@example.com
Phone Number of Person Submitting Application
Please enter a valid phone number.Format: (000) 000-0000.
Name of Agency CEO
First NameLast Name
Email of Agency CEO
example@example.com
Name of Board Chair
First NameLast Name
Email of Board Chair
example@example.com
Agency Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Agency Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Number of Agency Paid Staff
Number of Agency Volunteer Staff
Agency Mission Statement
Agency Vision Statement
Does the agency have a strategic plan?
Agency Update: Please provide a brief description of major accomplishments, significant issues, and barriers in the last twelve months.
List all agency fundraising activities and anticipated net dollars for each.
Rows Fundraising Activity Anticipated Net Dollars
Activity 1
Activity 2
Activity 3
Does the agency observe board term limits and maintain a rotating board?
What are the board terms (number of years)?
Should be Empty: