Grant Application - Gateway Wellness Foundation

This online application does not allow the user to save a partially completed application and come back at a later time to complete it. The application must be completed in one sitting.

Organization Name

Tax ID

Legal Name (if different than above)

Street Address

City

State

Zip

County

Phone

Annual Budget

Mission Statement

Website

Prefix

First Name

Last Name

Suffix

Title

Office Phone

Extension

Cell Phone

Project Name

Amount Requested

Counties served by grant

Burke Polk McDowell Rutherford

What needs/problems will be addressed by this grant?

Who will benefit from this grant?

How long do you anticipate funding to last (please provide a timetable for the project)?

Do you have other sources of funding for this project?

This is a one-year funding opportunity. How will you sustain the project in the future?

Describe the results you expect to have achieved by the end of the funding period.

Program budget with narrative (Supported file formats: Microsoft Word, Miscrosoft Excel, and PDF)

Other funding sources (a list of foundations, corporations or governmental agencies which funded the organization in the last fiscal year, including amounts contributed of $1,000 or more. Supported file formats: Microsoft Word, Miscrosoft Excel, and PDF)

Other Information you may want to include (Supported file formats: Microsoft Word, Miscrosoft Excel, and PDF)