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Grant Application Information Form

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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:

If different than the information above,
  • 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):
Access: