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GRANT APPLICATION

PREPARATION WORKSHEET
This worksheet is provided to assist you with preparation of your
grant application. It is not required to complete the application
process and will not be accepted as an official application. ALL official
grant applications MUST be completed and submitted online.

Click here for our online application.

Tab through the fields to complete the form on your computer, or print out the worksheet and write in your responses.

Date: ____________________________

Organization Name:____________________________________________________________________________________

Address:
__________________________________ _______________________________ ___________ _______________
(Street) (City/Town) (State) (Zip Code)

Telephone:_______________________Fax:______________________Email:______________________________________

Tax ID #:___________________________________________________

Program Name [if applicable]:____________________________________________________________________________

Grant amount requested:________________________________________________________________________________

Please state the mission of your organization:


_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________

Please identify the needs of your program:


_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________

Please list projected expenses this grant will cover:


_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________

Identify those who will benefit from the program and the number of those who will be affected:
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________

Form GA: 2012 • Page 1 of 2


Goddard Health Services, Inc. d/b/a The Goddard Foundation, 130 Liberty Street – Unit 12, Brockton, MA 02301 • 508-587-1114
The Goddard Foundation Grant Application

Identify the goal or expected outcome of the program:


_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________

If your organization has received funding in the past from the Goddard Foundation, kindly list the specifics of how the
funding has been utilized and who directly benefited from the funding: [If necessary, please attach a separate sheet]

_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________

The following documents must accompany this Grant Application:


• A Grant Proposal
• The most recent copy of your financial statement.
[For organizations, an audited financial statement of the organization is required.]

Questions should be directed to:


Attorney Maria Unda, Executive Director
Phone: 508-­­587-1114
E-­­mail: munda@thegoddardfoundation.org

This worksheet is provided to assist you with preparation of your grant application. It is not required to complete
the application process and will not be accepted as an official application. ALL official grant applications MUST be
completed and submitted online.

Please complete an official application online at:


https://www.grantinterface.com/Common/LogOn.aspx?eqs=ucxWAag0gAx33jgeFd5APvhPOVBUFUJoZ_PImjNYnh81

The Goddard Foundation does not discriminate on the basis of race, color, creed, religion, or sexualorientation.
Our mission is to educate, fund and support the general health of the community.

Form GA: 2012 • Page 2 of 2


Goddard Health Services, Inc. d/b/a The Goddard Foundation, 130 Liberty Street – Unit 12, Brockton, MA 02301 • 508-587-1114

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