CYTF Program Grant Application Cycle * March 1 September 1 Organization and Contact Information Organization Name * Program Director * Program Name * Address * Address Address Line 1 Address Line 1 Address Line 2 Address Line 2 City City State Colorado AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State Zip Zip Phone * Email * Amount of Grant Request * Type of Organization * 501(c)3 non-profit Other non-profit School OtherOther Check all that apply USTA Organizational Member? * Yes No Specify whether or not the Organization is a USTA Member Note: You must be a USTA Organizational member in order to receive a grant. Visit USTA.com to join. Is your program registered on Net Generation? * Yes No Note: You will need to register in order to receive a grant. Visit Netgeneration.com and register as a provider. Have you received support from the CYTF previously? * Yes No During which years did you receive support? * Program Information Safe Play Certified and Background Checked? * Yes No Are you and your instructors Safe Play Certified and Background Checked? Instructors must be Safe Play Certified and Background Checked. Visit Netgeneration.com. Number of expected program participants * Age range of expected program participants * Number of meetings each week * Estimate percentages in the following ethnic categories. Please enter a value for each ethnic group including other. Enter "0" for no percentage. % African American * % African American % Asian * % Asian % Caucasian * % Caucasian % Latino * % Latino % Other * % Other Program Start Date * Program End Date * Is more than one session being offered? * Yes No How many weeks in each session? * Agreement Checkboxes * I understand that this is a two-part process. A grant accountability report is required upon completion of the program. Signature * signature keyboard Clear Date * Program Description Describe the program for which funding is being requested. Target * Who will be targeted to participate in the program? Promotion * How will you promote the program in the community Grant Dollars * Specifically describe how grant dollars will be used. (Be sure to also reflect needs in your program budget) Success * How will success be measured? Funding * How will the program be funded long-term? File Upload Drop a file here or click to upload Choose File Maximum file size: 516MB Program Expenses Program Expense * Amount * Program Expense * Amount * Program Expense * Amount * Program Revenue Program Revenue * Amount * Program Revenue * Amount * Program Revenue * Amount * Program Revenue * Amount * Additional Program Expenses Program Expense Amount plus1 Add minus1 Remove Additional Program Revenue Program Revenue Amount plus1 Add minus1 Remove Total Program Expenses Total Program Expenses Total Program Revenue Total Program Revenue What is 4 + 2 ? Select One24681012 To ensure you are human, this question must be answered correctly for the Submit Button to appear. Submit
