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Group Application
Organization:
Contact Person
First Name: Last Name:
Address:
City: State: Zip:
Phone #: E-mail :
 
Description of organization and services provided: time in operations, approximate annual disbursements, persons served, etc.
Check the categories that most accurately describe your organization:
 
Homeless Shelter Sick/Hospice Disabled Services
Abuse/Battered Services Mental Health Drug Addition
Run Away Meal Shelter Other
Current source of funding and approximate annual budget
Describe reason for request and use of award
Amount of reward requested:
How did you hear about us?
Other (please specify below)
I authorize CPS Citizenship staff to verify information I have provided on this application.
 
Thank you for applying to the CPS Citizenshp Program. All applications are reviewed between the 20th and 30th of each quarterly month end. You will be notified that your application has been A) selected B) carried over to the next quarter or C) declined.