Request for Funding

Name of Organization(Required)

Address of Organization(Required)

Phone Number(Required)

Email(Required)

Non Profit Tax Identification Number of Organization(Required)

Please attach a copy of your IRS exemption letter verifying your 501(c)(3) tax-exempt status

What is the mission of your organization?(Required)

What service(s)/program(s) does your organization provide for Santa Cruz County?(Required)

Who specifically benefits from the services or programs your organization/program provides?(Required)

Amount of funding your organization is requesting:(Required)

How will the funds be used? Please be specific.(Required)

What is the duration of the program or service for which you are requesting funding?(Required)

How many Santa Cruz county children and/or families will be served by the program or service(s) for which you are requesting funds?(Required)

Additional information/comments