Site Map
Florence Copper
Committed to Florence
Committed to Pinal County
Application Form
Most fields are required. For any section that does not apply to your organization, please mark "N/A."
Grant Application
Organization Name:
Project Name (if any):
Organizational Information:
1. Organization's History:
2. Organizational Goals and Objectives (short-term and/or long-term):
3. Programs and Services (briefly describe your organization's programs and services):
4. Organizational Structure (board, staff, volunteers):
Proposal Information:
5. Description of Program/Project:
6. Description of Need (What is the issue you plan to address? What is your approach?):
7. Specific Activities (Include information about service delivery and/or timeline.):
8. Objectives and Goals for this Request (How will this grant strengthen the organization, address the issues, make improvements, or achieve success?):
9. Evaluation (What are the anticipated outcomes and how will you know if you are successful?):
10. Other (Use this space to provide any additional information that you feel would be relevant to this grant request that is not covered in the sections above.):
Budget Information:
Provide an explanation/justification of funding request and the amount
Grant Application Cover Sheet
Date of Application:
Organization Information
Name of organization
Legal name, if different
Address
City, State, Zip
Employer Identification Number (EIN)
Phone
Fax
Website
Name of top paid staff
Title
Phone
Email
Name of contact person regarding this application
Title
Phone
Email
Is your organization an IRS 501(c)(3) not-for-profit?
Yes
No
If no,
is your organization a public agency/unit of government?
Yes
No
Fiscal agent's EIN number
Proposal Information
Please give a 2-3 sentence summary of request:
Population Served:
Geographic area served:
Interest area of grant (check one)
Education
Environment
Cultural Heritage, Art & Tourism
Health & Wellness
Community & Economic Development
Funds are being requested for (check one)
General operating support
Start-up costs
Capital
Project/program support
Technical assistance
Other (list)
Project dates (if applicable):
Fiscal year end:
Budget
Total annual organization budget:
$
Total project budget (for support other than general operating):
$
Authorization
Name and title of top paid staff or board chair:
1575 West Hunt Hwy Florence, AZ 85132 Phone: 520.316.3755 Fax: 520.374.3999 View our
Disclaimer