Micro-Grant Application Form

The Interhelp Network’s

Micro-Grant 2023 Application Form

Applications are accepted on a rolling basis as long as funds last in calendar year 2023.

Before filling out this form, please review the Guidelines.

Name *

First

Last

E-mail *

Phone number *

Address *

1. How familiar are you with The Work That Reconnects (WTR)? Please describe your experience with the WTR. You may use a scale of 1-10 with 1 = “unfamiliar” and 10 = “very experienced.” *

2. Event title / brief description: *

3. Program date & likely venue: *

4. Sponsoring organization (if any):

5. Are you collaborating with others for this event? If so, please list (names are optional; we are interested in knowing if you have co-conveners). *

6. Who is your intended audience / participants? *

7. What is your goal for number of participants? *

8. To meet the micro-grant criteria, this event includes core aspects of the WTR (describe): *

9. Is your event being held in person or online? If in person, where? Is this event accessible to people in the Northeast United States? *

10. Does your event address priority focus area(s)? Refer to Guidelines. Describe how: *

11. Total micro-grant request: *

12. These funds will be used for: *

13. Do you intend to charge a fee or ask participants for a donation?

14. What are your other sources of funds, if any? *

15. If there is there anything else you would like to tell us about your event?

Phone

Submit

 

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