Name of Organization that will implement the grant.
Name of organization that will enter into contract with the County. Please make sure this is the legal name of the organization and it matches tax documentation.
Name of person responsible for grant coordination/implementation
Name of the person who will be signing the contract on behalf of the project.
Please put the mailing address for the contracting organization. This is the address your contract will be mailed to.
Format: 555 Main Street, City, CA ZIP
If multiple organizations are working together, please list
What type of project are you proposing
Please describe your project
Please provide the exact address where the activity will take place
Please describe the area served by the event. Where do most of the people who will attend the event/activity live?
Please indicate when the activity will start
Please indicate the date the activity will end
How often will this event happen?
Check the most applicable HTC populations
Select any sector that applies
Check any of the following languages supported at your event
List any other languages supported not listed
Estimate the number of people attending your event or number of individuals reached through your activity
Grants Requests are based on gaps in outreach (geographic and hard to count population), event /activity size, and ability for organizations to implement grant
Please use the budget template provided
Has your organization received funding for Census Outreach or Assistance Activities
If you have received other funding for Census 2020 Outreach or Assistance, please indicate who you have received funding from and what activities have been funded
Please indicate what other outreach you can provide
This field is not part of the form submission.
* indicates a required field