Mission + Outreach Grant Request

Please submit the form to be considered for a UCC Norwell Mission + Outreach Grant

Please select one

New Funding

Continuing Funding

Amount Requested

Organization

Contact Person

First Name

Last Name

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Telephone Number

(###)

###

####

Fax Number

(###)

###

####

E-mail address

Website

http://

Organization’s Mission Statement

What is the legal name of the entity to which grant checks, should they be awarded, be written to?

Please describe how you allocate funding for your organization (e.g., what percent is allocated to your administrative costs and what is the percentage allocated for other program support?)

What is the purpose of this funding request or the name of the project? Please include a brief description of how the funding will be used (e.g., “to supplement client travel expenses”)

Who will be the beneficiaries of this project? How many people? How will they be helped?

Are there opportunities for “hands-on” service with your organization? If so, please describe.

Is there any other information that we should have to best evaluate your proposal?

Reminder: Please submit a copy of your organization’s annual report or other appropriate documentation. Your application and annual report can be sent regular mail or via an electronic PDF to mission-outreach@uccnorwell.org