MINI GRANT APPLICATION

Sussex County Health Coalition is pleased to offer mini-grants up to $250 for member agencies seeking funding to “Go Purple.” These grants should be used for events within your organization to promote purple and spread awareness.

Delaware Goes Purple Awareness

Name of Group/Organization

Address of Group/Organization

STREET ADDRESS CITY STATE ZIP CODE

Adult Contact Name

Contact Phone Number

Contact Email Address

Event Information

Event Location

STREET ADDRESS CITY STATE ZIP CODE

Requested Amount - Up to $250.00

Proposed Activity / Event(Required)

Event must include & promote Delaware Goes Purple’s Awareness Campaign.

I Agree to Promote Awareness Campaign

Type of Event

Populations of Event - Check all that apply

Staff

Community

Projected Number of Participants

Do You Need Purple Materials?

Yes

If Yes, How Many Packets?

When Do You Need Materials?

We will make every effort to honor these material requests.

Please Describe the Proposed Purple Event

Electronic Signature of Person in Charge of Event

Please NOTE: Reports will be due 10 days after the event. Report format will be given at the time of award