Rapid Assistance Fund for Indigenous Communities & Individuals in Need: Application Form

Applicant First Name *

Applicant Last Name *

Applicant E-mail *

Are you applying as a(n) *

Individual

Community representative

Location of Community *

Are you requesting *

money

goods/services

both

Total Amount of Money Requested *

List of Goods or Services Requested *

(For example, food supplies, seeds, construction materials, grant writing assistance, volunteer labor, etc.)

Person in charge of money if awarded

Name *

Email or Phone *

Tell us a little bit about you, or the community, or organization (as relevant) with regards to the history and background of you or the group that is the focus of the need. Include links to your organization’s webpage, if applicable. *

(150–500 words)

What happened or is happening? Please describe the need and explain why the funding is urgently needed. *

(150–500 words)

Budget. Please explain what you will do with the awarded funds. Be detailed and specific of who will be involved, what the goal is, and what impact you expect it to have. It is important to explain in the application how the funds will be used to assist the review committee in understanding why you are requesting the amount that you are (give specific budget/prices) *

(150–500 words). The following categories should be used as applicable to your project: • Travel (car mileage, rental fees, airfare, etc.) • Lodging • Food or Beverage (No alcohol) • Medical Supplies • Other Supplies (such as printing costs, office supplies, telephone, etc.)

How did you hear about this Fund? *

Rapid Assistance Fund for Indigenous Communities & Individuals in Need: Application Form

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