SCC COTA Grant Application

First Name (Primary Contact)*

Last Name (Primary Contact)*

Legal Name of Organization*

Address*

Apt, Suite, etc. (Optional)

City*

State*

Zip*

Phone*

Email (not the grant writer)*

Executive Director’s Name*

Executive Director’s Phone Number*

Tax Identification Number*

Date 501(c)3 status was granted by the IRS*

Provide a brief description of the applicant organization. Include scope of services, programs, priorities, and plans. (500 characters max)*

Please limit your response to 500 characters.

Purpose of Program (Eight words or less…NOT the Program name)*

Grant Amount Requested*

How many children will be helped by this specific grant?*

Is your organization a past SCC grant recipient? If so, please click here to access the grant evaluation form. Evaluations are due at the same time as your grant application.*

Yes

Type of grant that best describes your program we will be funding:*

Critical: victims of sex trafficking, homeless, orphans, foster population, food security

Medical: illness, dental, disability, therapy

Educational: tutoring, literacy, after school programs

Geographic Areas Served (List each county and/or state):*

Provide a description of the proposed Program, including the Program goals. (500 characters max)*

Please limit your response to 500 characters.

Does the program you are applying for have other funding source besides SCC? If yes, please list below. (500 characters max)*

Please limit your response to 500 characters.

Did your organization volunteer with SCC in the prior calendar year?*

If yes, list the event(s).

* Indicates a required field

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SCC COTA Grant Application

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