Community Service Grant Application

Organization Name (if applicable)

Organization Website (if applicable)

Name *

First

Last

Street Address *

Street Address Line 2

City *

State *

Postal / ZIP Code *

Phone Number *

Email *

Describe Yourself or Your Organization *

STATEMENT OF ACCURACY FOR APPLICANTS: I hereby affirm that all of the above stated information provided by me is true and correct to the best of my knowledge. I hereby understand that I am also required to submit supporting documentation to complete this application. If chosen as a grant recipient, I consent to my picture being taken and used to promote the DeMarion Sankofa Foundation’s financial assistance program (recipient may waive photo due to unusual or compelling circumstances). Furthermore, I hereby understand that incomplete applications and/or applications that do not meet the eligibility criteria will not be considered for this grant. *

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