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Institute for Human Development Grant Application

State of Louisiana Funding 

Completion Of This Application Does Not Guarantee Funding
1.Legal Name of Organization:
2.Are you a 501c3 Non-Profit Organization?
3.Are you a For-Profit Organization (LLC, LLP, S-Corporation, etc.):
4.Are you a faith based organization? 
5.Year Founded?
6.Name of Director/CEO?
7.Email Address of Director/CEO:
8.Contact Person / Title (if different from Executive Director) of Who Will be Managing the Grant Funding?
9.Address of Organization? 
10.Phone:
11.Website:
12.Name of Proposed Project?
13.Purpose of Proposed Project?
14.Does the proposed project for funding already exist within your organization? Or, is this a new program?
15.Amount Requesting?
16.Proposed Project Goals?
17.Beginning and Ending Dates of Proposed Project (Must be completed by June 30, 2024)
18.Target group served?
19.Total number of individuals who will be served?
20.Geographic Area to be Served (city, neighborhood, parish, etc.):
21.I CERTIFY, TO THE BEST OF MY KNOWLEDGE, THAT:
If a grant is awarded to this Organization, the proceeds of the grant will not be distributed to or used to benefit any organization or individual supporting or engaged in politics, terrorism, or used for any other unlawful purpose.
I will provide receipts (i.e. paid invoices, cleared checks, sign-in sheets,etc) for all purchases and payments related to the grant.
I will provide a written report of all grant activities and services by June 30, 2024..

Type Your Name As The Electronic Signature (President/Board of Directors/Owner/Executive Director
22.Date:
Date / Time