2020 Amplify Grant

    Date

    Organization Name

    Street Address

    Apartment, suite, etc

    City

    State/Province

    ZIP / Postal Code

    Where will your project have the greatest impact? (This will help us determine which RiseVT Program Manager contacts you.)

    CONTACT PERSON

    Name (First Last)

    Email Address

    Phone

    FISCAL AGENT INFORMATION

    (THE FISCAL AGENT IS WHO THE CHECK WILL BE MADE OUT TO AND WHO THE W9 SHOULD BE FROM.)

    Name

    Email Address

    Phone

    Federal Tax ID Number

    Download a W-9 Tax Form

    CLICK HERE

    Upload Completed W-9 Form

    PROGRAM/PROJECT DESCRIPTION

    WE HIGHLY RECOMMEND THAT YOU COMPOSE THE BODY OF YOUR GRANT APPLICATION FIRST IN A DOCUMENT SUCH AS MS WORD, BEFORE CUTTING AND PASTING IT INTO THE ONLINE APPLICATION TEMPLATE

    Project Name

    Dollar amount requested

    Summarize your program or project in two sentences

    Provide a detailed description of your program or project.

    Describe which strategies in the Recommended Community Strategies and Measurements to Prevent Obesity in the United States from the Centers for Disease Control and Prevention your project/program is most aligned with.

    Find a summary of the CDC 24 strategies to reduce overweight and obesity here

    Find full details of the strategies by reviewing the CDC Implementation and Measurement Guide here

    Please provide a brief description of what RiseVT funding will pay for

    Additional supporting documents (if needed)