Non-Profit Organization Grant Request Form

Please submit your request ahead of time and allow for up to fourteen (14) business days for your request to be processed.

Contact Person Full Name *

Contact Person E-Mail Address *

Contact Person Phone Number *

Applicant / Organization Name Applying for Grant *

Your Wish List (Please provide a complete list with details.) *

Intended Use for Grant *

Additional Comments / Information Helpful in Processing of Request

Please submit any supporting documents to RepRabb@pahouse.net. Documents including, but not limited to project summary, draft support letter etc. Someone from Rep. Rabb’s staff will reach out to the email provided after submission to confirm receipt and schedule a meeting with the contact person, if needed.