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: 16.78MB 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 Add Remove Additional Program Revenue Program Revenue Amount Add 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 If you are human, leave this field blank.
