GRANT APPLICATION SUMMARY NAME OF ORGANIZATION______________________________________________ ____ DATE ORGANIZED_______________ ADDRESS___________________________________________________ _______ WEBSITE__________________________ CONTACT NAME____________________________________ CONTACT PHONE S___________________________________ CONTACT EMAIL ADDRESS____________________________________________ DATE SUBMITTED______________ AGENCY OBJECTIVE/PURPOSE: (DESCRIBE IN COMPLETE DETAIL) __________________________________________________________ __________________________________________________________ ________ TARGET POPULATION SERVED: (AGE, GENDER, SPECIAL INTEREST, ETC.) __________________________________________________________ __________________________________________________________ ________ TYPE OF FUNDING (CIRCLE) PROGRAM EQUIPMENT SPECIAL PURPOSE DESCRIPTION OF EXPENDITURE FOR WHICH FUNDING IS REQUESTED: __________________________________________________________ _________________________