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Application

Grant Application

Organization Address(Required)
MM slash DD slash YYYY
Max. file size: 128 MB.
Are you in good standing with the Secretary of State? (attach)(Required)
Max. file size: 128 MB.
Drop files here or
Accepted file types: jpg, gif, png, pdf, doc, docx, xls, xlsx, Max. file size: 128 MB, Max. files: 5.
    Drop files here or
    Accepted file types: jpg, gif, png, pdf, doc, docx, xls, xlsx, Max. file size: 128 MB, Max. files: 5.
      I certify that the aforementioned agency has received tax exempt status under the internal revenue code 501(c)(3).
      I certify that the aforementioned agency's organizing document and by-laws are up to date and applicable to the agency's current operation.
      I certify that the aforementioned agency has been incorporated as a non-profit organization for at least two years before completing this application.
      I certify that the aforementioned agency exists to serve people generally, and has adopted a policy of non-discrimination that is in compliance with all state and federal laws, applicable to persons served, staff employment and membership on its governing board.
      I certify that the aforementioned agency has filed a current form 990 with the Internal Revenue Service.
      I am the duly appointed representative of the aforementioned organization, authorized to certify and affirm statements of this eligibility determination form.
      Drop files here or
      Accepted file types: jpg, gif, png, pdf, doc, docx, xls, xlsx, Max. file size: 128 MB, Max. files: 5.
        Include name, title and date.
        This field is for validation purposes and should be left unchanged.