NRG and/or Disaster Preparedness Application

Use this form for grant requests relating to NRG and/or Disaster Preparedness. It will be reviewed by the Larkspur Disaster Preparedness Group, a subcommittee of LCF with knowledge and expertise relating to disaster preparedness.

If you have questions or would like to discuss your application feel free to contact us at terry@tjstern.com .

Individual Requesting Grant(Required)

Organization Requesting Grant if applicable

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Phone(Required)

Contact Person(Required)

First Last

Person Responsible for Managing the Grant(Required)

(Grant submitted by minors are to be managed with an adult)

Description of Project(Required)

Timeframe for Completion(Required)

Total Budget for Project(Required)

Amount of Request(Required)

Are you seeking funding from other sources?(Required)

Yes

Name the organizations and funding amount requested(Required)

We encourage applicants to provide matching funds or in-lieu contributions such as labor or materials.

Additional Information you'd like us to have

Signature of Applicant (and supervising adult if applicant is a minor)(Required)

Please enter your FULL NAME

Date Submitted

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