224-225 Account Application Form

County Law 224/225 Account Application

Use this form to request a secure Document Portal account.
You may complete this form if you are a representing agent or officer of an agency that receives 224/225 funding from the Rockland County Legislature and you need to request access to your agency's folder on the document portal.

This form is NOT for registering an agency for grant funding. If your agency is not a 224/225 grant recipient, DO NOT COMPLETE THIS FORM. You must contact the Rockalnd County Legislature to learn how to receive grant funding. You may contact the Rockland County Legislaurte regarding funding at leg224@co.rockland.ny.us.

NOTE: Before submitting this form you will need to complete and attach our Agency Contacts form [DOWNLOAD NOW].
Date

MonthDayYear
Date
Hour MinutesAM/PM Option
Name of Organization*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Representing Agent*

First NameLast Name
Phone Number*
E-mail*
example@example.com
Which grant are you applying for?

Community ServiceCultural Arts Grant
I am replacing a previously registered agent*

YesNo
Enter the name of the previously registered agent*
NOTE: Before submitting this form you will need to complete and attach our Agency Contacts form [DOWNLOAD NOW] below.
Attach Agency Contact Form

Upload the Agency Contacts Form that you completed seperately.
Cancelof
Short Description of Services*
Should be Empty:

County Law 224/225 Account Application