Application GFSS Grants Application Form "*" indicates required fields Organization Name* Founding date of organization* Month Day Year What is the organizations mission?*Organization Structure* Non-profit 501c3 Registered 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 FEIN*No spaces needed Person filling out this form*Full Name First Last Position title* Contact Number*Email* Website Social media handlesPlease provide all platforms Grant category applying for*General Health CarePreventative CareMental HealthHealth and TechnologyFinancial LiteracyYouth AthleticsCommunity DevelopmentEducation LiteracyReason for Grant* New product/ Program / Service Sustain/ Rebuild Program Expand a current program/ Product / Service What is the proposal for the funds requested*Please provide 1-2 page summaryTotal amount of funds requested*in dollars Please upload the current years budget:*Max. file size: 64 MB.Please submitt most recent audited financials or 990*Profit and loss statementMax. file size: 64 MB.Please upload a budget of what the funds will be used for?*Max. file size: 64 MB.By signing this form you confirm all the information submitted is accurate*VerificationPhoneThis field is for validation purposes and should be left unchanged.
