Grant Application for
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Mission Statement:
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Fiscal agent if applicant is not tax exempt:
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Tax ID Number:
37-2996532
Contact First Name:
Contact Last Name:
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Van Dam
Address:
05322 Camp Daggett Rd.
Email:
Phone Number:
2313301082
Project Name:
Project start and end dates:
Amount Requested:
$
200
Project Description:
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Goal of the Project
How many people will you reach?
What percentage are female?
100
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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G.
H.
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TOTAL EXPENSES
Proposed Expense
$
$
$
$
$
$
$
$
$
$
$
$