247 Micro Grant Request

Instructions:

  • Plan your event
  • Submit the form below with your grant request
  • Once approved, host your event
  • Within one week of your event, submit your receipts to the office for reimbursement up to the amount granted.

    *Today's Date:

    *Full Name:

    *Email:

    *Contact Phone:

    *Home Address:

    *Outreach Event Name:

    *Outreach Date:

    *Outreach Description:

    You can request up to $75 to help fund your outreach. How much are you requesting?

    If you chose "Other Amount", please indicate that amount here:

    *Signature