GSTF - Special Grant Application

Special Grant Application
Special Grants are only eligible to 501(c)(3) non-profits or other qualified charities.
Primary Contact Information
Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
About your Organization
Organization Name*
Organization Phone Number*
Please enter a valid phone number.
Organization Website
Federal Tax ID#*
Brief description of your organization*
Is your organization a 501(c)(3)?*

YesNo
Please upload documentation of your status as a non-profit

Accepted file types: pdf, doc, docx, jpg, jpeg, png, gif - Max file size 10mb
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About your Project
Brief description of the Project *
Number of persons to be served by your project*
How will the project affect the community?*

Project Financials*

	Amounts ($)
Grant Funding Requested
Applicant Match (if any)
Cash & Local Funds to be spent on project
Total of applicant's share
Total Project Cost

Proposed Starting Date for Project*

MonthDayYear
Date
Proposed Completion Date of Project*

MonthDayYear
Date
Problem to be addressed by the project*
Describe your long-range plan (ongoing management, how will it be funded in the future?):*
Previous funding received from Greater Seymour Trust Fund (please describe):*
Please upload any other supporting documentation related to your project

Accepted file types: pdf, doc, docx, jpg, jpeg, png, gif - Max file size 10mb
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SIGNATURES

TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA CONTAINED IN THIS APPLICATION IS TRUE AND CORRECT.

THIS DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT.

Periodically, the media will cover activities at the Greater Seymour Trust Fund. By signing below, you are giving the media and the Greater Seymour Trust Fund permission to use your organization’s name, your name and/or picture in the publicity.
Name of Authorized Representative*
Signature of Authorized Representative*

Clear
When you are ready, please click on the submit button below once. It may take a few moments to upload your files, so please be patient while this process occurs.
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Special Grant Application