Discretionary Grant

Date (mm/dd/yyyy)*

Name of Applicant Organization*

Dollar Amount Requesting*

Project Title (5 words or less)*

Target Population*

Brief Summary of Request*

Contact Person*

First Last

Title*

Email*

Address*

Street Address City State ZIP Code

Phone*

Website

FEIN Number-Enter your organization's Federal Tax Identification Number.*

For SCF use only: Notes

For SCF use only: Is 501c3 current

For SCF use only: Gave to Tara for Review

For SCF Use only: Approval

For SCF use only: Follow Up Report Received

Name

This field is for validation purposes and should be left unchanged.

Discretionary Grants