Ingham County
Community Agency Application
Resume Application
APPLICANT INFORMATION  (* indicates required field)
1. Organization *
2. Contact person * Title 
3. Alternate contact * Title 
4. Email address *
Ingham County communications regarding community agency funds shall be sent to this email address.
5. Organization's address *
6. Phone number *     Fax number 
7. Website address
8. Proposal title *
9. Amount requested * $
10. Federal tax ID number *
11. Please indicate the names and titles of persons who are authorized to execute agreements on behalf of your organization *
Name  Title  
Name  Title  
12. Nonprofit organization * Specify other
13. Business organization (profit)
14. Unit of government including schools (specify)
15. Not incorporated (specify legal and/or professional status of the requesting individual)

16. How long has the applicant's organization been in business? *
17. What is the number of full-time equivalent positions currently employed? *
18. How many volunteers are curently involved?  *
19. a. How does your proposal involve coordination or collaboration with County services, other local governments, or other agencies? *   
      b. What other programs similar to your program are operating in the County? *     

20. Is this your first request from Ingham County? *
21. a. Have you sought funds for this proposal or concept from any other entity? *
Please identify who and the response.    

       b. Does the proposal anticipate utilizing funds from other sources? *
       c. To what extent is the other funding assured?

22. Is your organization currently a member of the Power of We Consortium? *