Organization InformationOrganization Name Organization 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 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 CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
