Grant Application - 2022

Has your Arizona 501 (c)(3) organization reviewed grant guidelines by clicking orange ‘Review’ button above? Does your organization meet all of the eligibility requirements? Has your organization been established for at least 3 years? *

Yes No

Failure to answer 'yes' to above questions will result in an automatic decline.

Unfortunately, your organization does not qualify for a General Grant due to not meeting the eligibility requirements.

Category*

Organization*

Website*

Mission Statement*

Annual operating budget amount?*

EIN*

Name of individual filling out this form*

First Name

Last Name

Name of Executive Director/CEO*

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Phone*

Phone number of person filling out form

Email*

Email of person filling out this form

Enter the ethnicity range of the participants you serve

% of Black/African American*

% of Hispanic/Latino*

% of White/Caucasian*

% of Native American, American Indian or Alaskan Native**

% of Asian*

% of Two or more races*

% of Unknown*

Totals must add up to 100%

Does your organization serve any children/youth with the following difficulties? Check all that apply. *

Hearing difficulty Vision difficulty Cognitive difficulty Ambulatory difficulty Self-care difficulty Independent living difficulty Other/Data not Collected

If you know the percentage of the difficulty you selected, please enter in text box.

% Hearing difficulty

deaf or having serious difficulty hearing (DEAR)

% Vision difficulty

blind or having serious difficulty seeing, even when wearing glasses (DEYE)

% Cognitive difficulty

Because of a physical, mental, or emotional problem, having difficulty remembering, concentrating, or making decisions (DREM)

% Ambulatory difficulty

Having serious difficulty walking or climbing stairs (DPHY)

% Self-care difficulty

Having difficulty bathing or dressing (DDRS)

% Independent living difficulty

Because of a physical, mental, or emotional problem, having difficulty doing errands alone such as visiting a doctor’s office or shopping (DOUT)

Other/Data not Collected

Please convert all your documents to pdf. You can do so for free here.

Note: When using Save & Resume, files uploaded to the form by the end users will NOT be saved to the form until the form is submitted to the database. Users should not upload files until they are ready to submit.

Upload a document that highlights the demographics (by percentage), such as the race of the target population you intend to serve.* No File Chosen