Grant Support Request Form

Please complete all sections on this form to seek grant funding and/or letters of support for grants and low-interest loans.

Government Entity or Organization applying for a grant *

Applicant Mailing Address *

Applicant City *

Applicant State *

Applicant Zip Code (5-digit) *

Support Letter Contact Person *

Support Letter Contact’s Phone Number: *

Support Letter Contact’s Email Address *

Leaving this box checked verifies that you would like to receive legislative email updates.

Support Letter Contact’s Title/Role *

Project Name *

Application ID Number (if applicable)

County *

Municipality *

Brief Description of Project *

How would this money be used? *

Brief Impact of Project *

Requested Amount *

Total Project Cost *

Funding Program Name *

Funding Source (Agency, Department, etc.) *

Type of Funding *

Addressee Name for Support Letter *

Addressee Title for Support Letter *

Addressee Mailing Address *

Addressee City *

Addressee State *

Addressee Zip Code(5-digit) *

Support Letter Due Date *

Name and email of other individuals requiring copies