GRANT SUPPORT LETTER REQUEST FORM

Please complete this form three or more weeks prior to the due date of your grant.

Organization Requesting Support *

Individual requesting on behalf of organization (please complete all fields).

Full Name:* First Name:*

Last Name:*

Email Address: *Email: *

Address: *

City: *

State: *

Zip Code: *

Phone Number: *Phone: *

Grant Deadline/Due Date for Support Letter *

Where does the letter need to be sent (email, name, title)? *

Who should the letter be addressed to (name/title/address/email)? *

Grant Funding Name/Title *

Is the Funding Source State or Federal? *

Vendor Number or Grant ID Number. *

Grant Amount/Funding Request. *

Bio of organization requesting support (4 to 5 sentences). *

How has the organization impacted the community (4 to 5 sentences)? *

What will the funds be utilized for and how will this impact constituents (4 to 5 sentences)? *

Rep. Izzy's involvement or visitation to the organization, if any (4 to 5 sentences).

If applicable, please email template letters, program descriptions and a copy of the funding application to RepSmithWadeEl@pahouse.net.