Grant & Sponsorship Request Form

Type of Request *GrantSponsorship / Emergency Small DonationScholarships are requested through the scholarship program.

Organization *

Date *

Physical Address *

City *

State *

Zip Code *

Contact Name & Title *

Telephone Number *

Email Address *

Organization Website

Federal Tax ID Number *

Organization Type *Non-Profit / CharityAcademic InstitutionReligious Organization

Year organization was founded

Service Area

Number of people served by your program

Is the organization registered in the state of Maryland? *YesNo

Has the organization received support from the SIAB in the past? *YesNo

If yes, when?

Amount of support?

Grant

Grant Type / Amount(Only requests for grant amounts described by the SIAB will be accepted; urgent/emergency need small donations will be individually evaluated. If not applying for the Large Grants listed on the website, please do note that Small Grants cannot exceed $2,000. See the SIAB website for our grant policies.)

Please describe in detail how the grant would be used for the purposes of your organization.

Sponsorship

Amount Requested

Name and description of event (including date and location)

Additional Attachments

Signature *Enter your full name.