Special Needs Scholarship Application for Nonprofit Organizations

Date
MM slash DD slash YYYY
Nonprofit Organization Requesting Funds*
Nonprofit Organization Mission Statement
Nonprofit Organization Address*
Street Address Address Line 2 City State ZIP Code
Contact Person*
First Last
Contact Person's Title*
Email*
Phone*
Amount of Request
Current Sources of Income*
Include answers to the following questions in your proposal
What do you hope to accomplish if your agency receives this scholarship? How do you plan to accomplish it? How many individuals will be served by the requested funds? (Any summer activities may be included.)
Proposed Use of Funds:*
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Include answers to the following questions in your proposal