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* 1. Contact name and role/title:

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* 2. Organization applying for grant:

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* 3. Likely recipients of transportation match grants are well-positioned to bring advocates from underrepresented regions and communities to Advocacy Day. Please explain how the advocates you will bring represent a new or underrepresented constituency at Advocacy Day. In addition to providing transportation, how will you support these advocates in overcoming barriers to participation?

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* 4. Likely recipients of transportation assistance grants will demonstrate capacity for and commitment to bringing low-income residents directly impacted by the issues to Advocacy Day. Please briefly describe your plan for outreach to low-income residents, and describe how an assistance grant would help you bring new advocates to Advocacy Day.

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* 5. If your organization receives a transportation assistance grant, how many more advocates would you be able to support coming to Advocacy Day on January 28, 2014?

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* 6. Please describe any partnerships or coalition work with other organizations with which you are interested in sharing a transportation assistance grant.

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* 7. Amount of funding support you are seeking: $_______. 00

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* 8. Please share any other information you think will help us better understand your organization's role in supporting advocates with a transportation assistance grant.

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