If approved, check will be sent to this address.
Mailing Address:
City: State: Zip:
Phone #: Contact Person:
Email Address:
To whom should the check be written:

Budget information must be filled out for application to be considered.
Total Program Budget:
Amount Requested from the CRA:
Percent of program budget:

Is this the first time you have requested funding for this program.

1. Agency/Program description:


2. Please provide a brief description of how funds would be used


3. How will your use of CRA dollars help meet the critical needs of your community?


4. Please explain what types of fundraising activities you have planned for this year, and what other funding sources you plan to approach to help meet this need?


5. How would you modify your program if the full amount you are requesting is not available?


6. Please describe the target population your program serves and the needs of this population. Example: 10 boys ages 6-8 years old from low income families need scholarship to play baseball.