Grant Program Application

Note: Fields marked with an * are required.

In accordance with the Privacy Act of 1974, I give Congressman Brian Mast authority to act on my behalf.

Your Organization Information

Today's Date:

Organization Name: *

Contact Person

Prefix: *

Mr. Mrs. Ms. Miss Dr. Hon. Rev. Rabbi

First: *

Middle:

Last: *

Suffix:

Street Address: *

City: *

State:

AL AK AZ AR CA CO CT DE DC FL GA HI ID IN IL IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip Code: *

Phone: *

Fax:

Email: *

Organization Website:

Grant Information

Federal Agency:

Grant Administrator/Contact Person: *

Street Address: *

City: *

State:

AL AK AZ AR CA CO CT DE DC FL GA HI ID IN IL IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip Code:

Phone: *

Fax:

Email:

Federal Project/Grant Name: *

Federal Project/Grant Website: *

Grant Reference # (If appropriate):

Grant Application Deadline (or date on which you require a letter of support):

Purpose of Grant (Federal Government’s description of what these funds are to be used for): *

Stated Goals/Objectives/Outcomes of Organization Applying for Funds (Brief description of what your organization will use these Federal funds, if selected): *

Sample Letter

Send a sample of the letter your organization would like our to submit to the Federal agency via email to  FL18grantrequest@mail.house.gov. Please:

1. Attach the letter you want Rep. Mast to submit in Word Format
2. Title the subject of the email the name of the contact person in your organization for this request