Organization InformationOrganization NameOrganization PhoneAddress Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact PersonTitleEmail Total Organization Budget# FT Staff# PT Staff# Volunteers# of Board Members% of Board Members who financially support the organizationProvide a brief history of your organization and its mission.175 words or lessProgram or Project InformationProject TitleDescribe your project, service or program this proposal is addressing.200 words or lessProject Timeline/Key MilestonesMilestoneProjected Start DateProjected End Date Provide a project timeline- beginning and ending datesShare one story of how this program or project has impacted or will impact youth (under 21 years of age) in the North Coastal area.150 word maximumProgram or Project BudgetAmount RequestedGrant range is $2,500 to $6,000Total Program/Project BudgetInclude a summary of your program or project budget.Of your program or project budget, which items are you requesting support for from the Mental Health Fund?Please list other sources of income and potential amounts for this program or project (i.e. foundation grants, government funds, event income, private donors, etc.)Please indicate that you have sent a copy of your operating budget to grants@coastalfoundation.orgYesNoCAPTCHAEmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.
