Allegany Franciscan Ministries

Capacity Building Scholarship Application Form - Tampa Bay Region

All fields are required.

Organization Name:
Mailing Address:
Suite or Unit #:
City:
State:
Zip Code:
Telephone #:
Fax #:
Contact Person:
Title:
E-Mail Address:
Briefly describe your organization (100 words or less):


EVENT INFORMATION
Event Name and Description (100 words or less):

Name of individual(s) attending:

Title of individual(s) attending:

What will the individual(s) gain from attending the event? (100 words or less):

Date of event:


FINANCIAL INFORMATION
Total registration cost:

Estimated travel costs with description: (e.g. transportation, hotel)

Amount of support requested by Allegany Franciscan Ministries:


LASTLY, please email or fax the following items: 1) Copy of organization's 501(c) (3) ruling issued by the Internal Revenue Service (unless you have received a grant from Allegany Franciscan Ministries since 2007). 2) Copy of the brochure and registration forms for the event. Attn: Jessica Gonzalez, Grant Coordinator E-mail: grants@afmfl.org Tel: (727) 507-9668 Fax: (727) 507-8557

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