COVID-19 Response Grant Application

Applicant Information

The supplemental CIP funds must be used to address needs stemming from the COVID-19 public health emergency to ensure the safety, permanence, and well-being needs of children are met in a timely and complete manner. Please refer to the COVID-19 Response Grant Guidelines and Instructions for allowable activities.

The online application will identify the applicant’s Internet Protocol (IP) address once information has been entered into the application. This will allow you to return at a later date if needed. To return to application that has been started, follow the link from the same computer initially used to start the application.

Question Title

* Requestor is designated as a(n):

State Agency

Unit of Local Government

Non-Profit Organization

Educational Institute

Other

Question Title

* Please provide authorized official's contact information.

Name:

Company:

Address:

Address 2:

City/Town:

State:

ZIP:

Email Address:

Phone Number:

Question Title

* Organization Description:
Describe your organization. Some suggested items to include: a brief statement of your organization’s mission, a list of your core services, recent major accomplishments, and clients served or services provided.

Question Title

* Requested Grant Period:

October 1 to September 30 (current Fiscal Year)

Other (please specify)

Question Title

* Requestor is designated as a(n):

Question Title

* Please provide authorized official's contact information.

Question Title

* Organization Description: Describe your organization. Some suggested items to include: a brief statement of your organization’s mission, a list of your core services, recent major accomplishments, and clients served or services provided.

Question Title

* Requested Grant Period:

* Organization Description:
Describe your organization. Some suggested items to include: a brief statement of your organization’s mission, a list of your core services, recent major accomplishments, and clients served or services provided.