Grant Application for
hestiaccircle
Mission Statement:
Fiscal agent if applicant is not tax exempt:
Tax ID Number:
Contact First Name:
Contact Last Name:
Jean
Van Dam
Address:
05322 Camp Daggett Rd.
Email:
Phone Number:
2315822323
Project Name:
Project start and end dates:
Amount Requested:
$
Project Description:
Goal of the Project
How many people will you reach?
What percentage are female?
If your program serves both males and females, how will Hestia funds specifically target women and girls?
How are recipients identified or selected to receive services? Is financial need considered?
What do you hope to achieve? What difference will this make in the lives of women and girls?
How will this project meet Hestia's mission statement?
How will you evaluate or measure your success:
Grant Project Budget Form
REVENUES
Revenue Item
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TOTAL REVENUES
Proposed Revenue
Pending or Confirmed
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
EXPENSES
Expense Item
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B.
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J.
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TOTAL EXPENSES
Proposed Expense
$
$
$
$
$
$
$
$
$
$
$
$