Grant Request Form

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Contact First and Last Name

Email

Organization Website

Program(s)/project(s) supported by grant

Capitol

Employee Position

Program

Other

If "other" specify details

Phone

Organization Name

Amount of Funds Requested

Time period for funds to be dispered over (i.e. $20,000 annually for three years)

University partner who will be quantifying outcomes/measurements

Purpose and Outcomes to be Produced By Grant Funding

Other information

Upload Organization 990, Audited Financial or Annual Report (if applicable)

Upload supported file (Max 15MB)

EIN 83-0572687

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