Grant Application Form

APPLICANT:

Organization Name

Status

CONTACT PERSON:

Phone

Address

Zip Code

City

State

ORGANIZATION:

Purpose

Area Served

Amount

Expenses

Are you submitting grant requests to other organizations

Use

Beneficiaries

Mission

More Info

Have you apply for funding with Connexus Association in the past 12 months

Source

I certify that the information provided in this application is correct to the best of my knowledge. I understand that Connexus Association may request additional information as their Board of Directors reviews this request.

Signature

Date