2024-2025 WITAN Grant On-Line Application

Agency Name *

Address

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Contact Name *

First

Last

Phone *

Email *

Website / URL

Non-Profit Tax I.D. #

Amount Requested

Itemize Project Request

Explanation of Project

Project Timetable

Brief Synopsis of Services Provided by Your Organization/Agency

Counties and/or Communities Served by Organization/Agency. Specifically, what percentage of services are provided to Summit County Residents?

How many people receive services from your Organization/Agency on a yearly basis?

How do you plan to promote WITAN's support of your agency/project? (check all that apply)

• Newpaper
• Website
• Agency Press Release
• Brochure
• Social Media
• Other

If "Other", please describe your plan to promote WITAN’S support.

If you received a WITAN grant during the prior grant cycle, please provide a brief impact statement. Also explain if any unforeseen delays or changes have been necessary regarding last year's funded project.

Name

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