2022 SAM Grant ApplicationSAM Grants (2022)Please enable JavaScript in your browser to complete this form.Name of Organization *Name of Organization's Director *FirstLastAddress of Organization *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeOrganization's Phone Number *Organization's Website *Name of Organization's Contact Person *FirstLastEmail of Organization's Contact Person *EmailConfirm EmailOrganization's core focus, mission, a/o activities: *Number of people that your organization serves:Grant Amount Requested: *(In US Dollars)Please describe how the requested funds would be used. *Please provide the justification for the requested grant funds. *Expected timeline and the approximate number of people who would benefit from the requested grant: *How will you measure success for the grant funded program? *Total Size of the Organization's Annual Budget: *(In US Dollars)Please identify percentages of your annual budget income received from: 1) local and county government; 2) Federal government; 3) charitable foundations; 4) churches; 5) individuals; 6) program service; 7) other. *Exact name of organization as it should appear on the check: *Exact address for mailing the check: *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHave members of Rock Spring UCC been involved in the activities of your organization? *YesNoI don't know.If so, please list the names of volunteers from Rock Spring UCC:Do you have volunteer opportunities that might be filled by members of Rock Spring UCC? If so, what areas?Our congregation is working to become a more just, anti-racist congregation. Has your organization taken steps in this type of work? Have you had any successes you wish to share?Name *FirstLastSubmit