Support Us
Home
About Us
The Program
Grant Request
Contact
Volunteer
GIVE
Designated Gifts
Haven of Rest Ministries
ECHS/CAMP
GRANT APPLICATION
TOPUCU PROGRAM GRANT APPLICATION
*
Indicates required field
Date of Application
*
Organization Name
*
Mailing Address
*
Line 1
Line 2
City
State
Zip Code
Country
Email
*
Phone Number
*
Fax Number
*
Federal Tax Identification Number
*
Contact Person
*
Title
*
Person Completing Application
*
Direct Phone
*
Email Address
*
Are you a 501(C)3 Organization?
*
Organizational Background Information
A. Mission of Organization
*
B. Population Served
*
C. Services Provided
*
D. Approximate number of clients served annually (if applicable)
*
E. What is your geographic service area?
*
F. What is your gross annual revenue?
*
G. Year Incorporated
*
H. State of Incorporation
*
I. Number of Total Employees:
*
J. Name of any Affiliate, Subsidiary, or Parent Organization
*
K. Executive Director/President
*
L. Board Chairperson
*
Program Request
A. How many programs are you requesting?
*
B. Briefly describe the format and overview of how you would like to incorporate the program into your current operations?
*
C. Will you need facilitator training?
*
D. When would you like to start the program?
*
E. Do you have funds for the program? If so, how much?
*
Financial Information
A. Fiscal or accounting year ends
*
B. Staff member responsible for financial reporting and management
*
C. Financial statements are prepared by
*
D. Board Treasurer
*
E. Does the Board have a Finance Committee?
*
Yes
No
Certification of Application
Name
*
First
Last
Date
*
Send Application
Home
About Us
The Program
Grant Request
Contact
Volunteer
GIVE
Designated Gifts
Haven of Rest Ministries
ECHS/CAMP