Please fill in the Funding Request form below:
The funding requests period has closed for the 2015-16 funding year. Check back soon for the opening of the 2016-17 funding requests period.
Sponsored Programs Funding Request Form
Please indicate the type of services that will be provided under this funding request along with the number of visits and clients served in the prior year:
Number of Services Provided in 2014
Estimate of Additional Services that will be provided with Funding Requested
Are there any other funding sources contributing to this project?
(Please list sources and amount of investment)
If yes, please indicate by the amount of funding and how the funding was used:
CEO / Executive Director Signature:
Correspondence via Email: “Under Florida law, email addresses and all of the information contained in the emails are public records. If you do not want your email address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing.”
Mandatory field(s) marked with *