Grant Application Information Form

This sample application was taken from the Massachusetts Cultural Council grant application. The submitted application need not look exactly like this, but should contain the same information.

Submission date:

Applicant Information

• Applicant name:
• Applicant name also known as:
• Address:
• Mailing Address (if different):
• City/State/Zip:
• Chairperson (name, title):
• Executive Director (name, title):
• Project contact (name, title):
• Email address:
• Daytime telephone:
• Fax:
• Summarize the mission of your organization:
• Last fiscal year total income:
• Last fiscal year total expenses:

Project Information

• Title of project:
• Summary of proposed project:
• Project start date:
• Project end date:
• Number of individuals directly participating in/benefitting from this project:

Amount Requested:

• To whom should the check be made out to?
• Where should it be mailed to?

Authorized Signature:

The signature below is that of the person authorized to testify as to the accuracy of this application (signature/title/date):