Grant Application

LVAIP Grant Application

Fields with an asterisk (*) are required.

Organization(*)

Please enter your city.

Year Established(*)

Year Established

Contact Name(*)

Please type your full name.

Title

Please enter year of high school graduation

E-mail(*)

Invalid email address.

Address(*)

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City(*)

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St(*)

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Zip(*)

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Phone

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Fax

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Describe goals of organization (max 300 words)(*)

Describe goals of organization (max 300 words)

Describe project, program, operational costs for funds requested (max 300 words)(*)

Describe project, program, operational costs for funds requested (max 300 words)

Describe the geographical area your project or program serves (max 300 words)(*)

Describe the geographical area your project or program serves (max 300 words)

Who is served by this project or program (excluding Staff).(max 300 words)(*)

Who is served by this project or program (excluding Staff).(max 300 words)

Lehigh Valley Aging in Place is a Coalition of professionals from private, public, non-profit and business sectors
to inform, educate and help older adults age in place.
We provide information and solutions dedicated to helping families help seniors.

Grant amount - $1,000.00

Fiscal Year (eg: Jan-Dec)(*)

From ___ to ____

Current Budget:

Total Expenses(*)

Enter current total expenses

Total Income(*)

Enter current total income

Earned Private Revenues(*)

Enter government revenues

Gov't. Revenues(*)

Enter government revenues

Previous Fiscal Year Budget

Total Expenses Previous Year(*)

Enter total expenses previous year

Total Income Previous Year(*)

Enter total income previous year

Earned Private Revenues Prev(*)

Enter government revenues

Gov't. Revenues Previous Year(*)

Enter government revenues previous year

# Paid Staff(*)

Enter number of paid staff in organization

# Volunteer Staff(*)

Enter number of volunteers in organization