Organization Information

Organization Name:

Address:

City:

State:

Zip code:

Telephone:

email Address:

Website (Optional):

Name/title/contact information of representative:

How long has your organization been in existence?

What are its other sources of funding (government grants, corporate support, individual donations)?

Summarize your organization’s mission and the clients/community it serves:

List your organization’s governing board, officers, key staff and any ad hoc or advisory committee members (or attach list to this application):

Project Information

Project title:

Area and client group to be served:

Anticipated project duration (Is it already underway? How long will it last?):

Project description (include what kind of support exists for this project, the needs it will serve, and how the requested funding from YCCF would be used)::

Requested funding amount (USD)*:
(*Please attach the planned budget for the project.)

Please enter the characters from the image above into the following form:

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