Name of Organization *

Physical Address *

Mailing Address *

Website

Email *

Phone *

Fax

Applicant Type * Federal, State or Local Governmental entity Florida Non-Profit

List Officers and Board Members with contact information *

Provide evidence of an established checking account, input EIN *

A Contract Manager for the organization will electronically sign and submit applications. This person must have signatory authority for the organization and is responsible for ensuring that all elements of the Grant Program are followed, including maintaining the official files that include the application, correspondence, contract, progress reports, request for funds, invoices, and samples of promotional materials submitted. This also includes being responsible for the integrity and accuracy of all material, as well as ensuring that all applicable Federal, State, or County laws and policies are followed.

Contract Manager *

Contract Manager Email *

Contract Manager Phone *