Grant Support Request Form

Please complete all sections on this form to seek grant funding and/or letters of support for grants and low-interest loans.

Applicant First Name

Applicant Last Name

Government Entity or Organization applying for a grant

Applicant Mailing Address

Applicant City

Applicant State

Applicant Zip Code (5-digit)

Support Letter Contact Person

Support Letter Contact’s Phone Number:

Support Letter Contact’s Email Address

Support Letter Contact’s Title/Role

Application ID Number (if applicable)

Municipality

Brief Description of Project

How would this money be used?

Brief Impact of Project

Requested Amount

Total Project Cost

Funding Program Name

Funding Source (Agency, Department, etc.)

Type of Funding

Addressee Name for Support Letter

Addressee Title for Support Letter

Addressee Mailing Address

Addressee City

Addressee State

Addressee Zip Code(5-digit)

Support Letter Due Date

Should the letter be sent via email or hard copy?

Do you require support letter copies?

Name and email of other individuals requiring copies

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