Grant Application

LVAIP Grant Application

Fields with an asterisk (*) are required.

Organization(*)

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Year Established(*)

Year Established

Contact Name(*)

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Title

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E-mail(*)

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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)

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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(*)

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Total Income(*)

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Earned Private Revenues(*)

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Gov't. Revenues(*)

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Previous Fiscal Year Budget

Total Expenses Previous Year(*)

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Total Income Previous Year(*)

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Earned Private Revenues Prev(*)

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Gov't. Revenues Previous Year(*)

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# Paid Staff(*)

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# Volunteer Staff(*)

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