Action Grant Application Action Grant Application "*" indicates required fields Organization/Individual's Name* Mission Statement:*Project Goal:*Amount of This Request*Request may be up to $500.Total Cost of Project*Proposed Project Description:*Project Start Date* MM slash DD slash YYYY Project End Date* MM slash DD slash YYYY Contingency Plan*Will the project be able to go forward if full funding is not received?Examples of Past Projects* Drop files here or Select files Max. file size: 8 MB, Max. files: 5. Attach one of the following: resume, Board of Directors list, or letter of support from community/organization leader*Max. file size: 8 MB.Certification* I certify that the information contained in this application, including all attachments and supporting materials, is true and correct to the best of my knowledge.Name of Authorizing Official* First Last Signature*Phone*Email* Mailing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code
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