Scottsboro - Grant Application

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Lozier Community Grant Application – Scottsboro

Lozier recognizes the value of giving back to the communities where we do business. Registered 501c3 organizations are invited to apply for funding for programs within our core focus areas of Education, Social Services, and Community Building.

INFORMATION

Name of Charity *

Tax ID / EIN *

Address *

City *

State *

Zip Code *

Website *

Email *

Phone Number *

Key Contact Name *

Contact Title *

Mission Statement or Short Description of Organization *

PROGRAM, PROJECT or EVENT DETAILS

Requested Grant Amount *

(minimum $3000)

Choose one: *

General Support
Support of specific program or event
Capital project

Program / Project / Event Name *

Location of Program / Project / Event *

Number of Participants *

Program / Project / Event Name Details *

What are the anticipated outcomes and how would receiving this grant help achieve these goals? *

COMMUNITY FOCUS

Which focus area does this request align with: *

Education
Social Services
Community Building

Education

Programs that focus on mentoring and career development
Programs that provide direct support to schools

Social Services

Programs meeting basic health, welfare, and other needs of the underprivileged, sick, or elderly

Community Building

Programs that make our communities a positive, interesting place to live and raise a family

Does this event / activity / program reach a vulnerable population? Check all that apply *

Persons with disabilities
Racial, cultural, or ethnic minorities
Veterans and/or military personnel
Women
None

Ages of those impacted by the event / activity / program: *

All Ages
Infants
Children
Teens
Adults
Seniors

LOZIER VOLUNTEERS

How many Lozier employees volunteer with your organization?

None
One
Two
Three
Four
Five
More than 5

Employee # 1 Name

Role:

Employee # 2 Name

Role:

Employee # 3 Name

Role:

Employee # 4 Name

Role:

Employee # 5 Name

Role:

List all Name (ex, Joe Smith - board member, Jane Doe - volunteer)

DOCUMENT UPLOAD

Supporting documentation for the organization or program including board listings, budget, marketing materials, etc.

Click or drag files to this area to upload. You can upload up to 5 files.

Phone