Grant Support Request Form Please complete all sections on this form to seek letters of support for grants and low-interest loans on behalf of an organization or government entity. A staff member will be in contact with you. Applicant First Name * Applicant Last Name * Government Entity or Organization applying for a grant * Applicant Mailing Address * Applicant City * Applicant State * PA AA AE AK AL AP AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY Applicant Zip Code (5-digit) * Support Letter Contact Person * Support Letter Contact’s Phone Number: * Support Letter Contact’s Email Address * Leaving this box checked verifies that you would like to receive legislative email updates. Support Letter Contact’s Title/Role * Application ID Number (if applicable) * Municipality * Brief Description of Project * How would this money be used? * Brief Impact of Project * Requested Amount * Total Project Cost * Funding Program Name * Funding Source (Agency, Department, etc.) * Type of Funding * Addressee Name for Support Letter * Addressee Title for Support Letter * Addressee Mailing Address * Addressee City * Addressee State * PA AA AE AK AL AP AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY Addressee Zip Code(5-digit) * Support Letter Due Date * Should the letter be sent via email or hard copy? * EmailHard copy Do you require support letter copies? * YesNo Name and email of other individuals requiring copies Submit