Organization InformationOrganization Name Organization PhoneAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Person Title Email Total Organization Budget # FT Staff # PT Staff # Volunteers # of Board Members % of Board Members who financially support the organization Provide a brief history of your organization and its mission.175 words or lessProgram or Project InformationProject Title Describe 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 Requested Grant range is $2,500 to $6,000Total Program/Project Budget Include 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.org Yes No In addition to submitting this application, please send the following documents by the deadline to: grants@coastalfoundation.org* Current Financial Statements: 1) balance sheet, 2) profit and loss statement, 3) current year budget Federal Tax Status If you have not applied to CCF previously, please email a copy of your IRS 501(c)(3) federal tax exempt letter CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
