COMMUNITY CRIME PREVENTION AWARD PROGRAM APPLICATION

Group Seeking Funds:

Project/Program Title:

Incorporated?: Federal Tax Identification Number:
AUTHORIZED APPLICANT REPRESENTATIVE:
Print Name:

Street Address:

City, State, Zip:

Business Phone:

Cell Phone:

E-mail address:
*All notifications will be made via email communication.
If funding is awarded, make check payable to:

Brief description of your project/program and expected benefits to the community:

Is this project new or ongoing?:
New Ongoing
Which of these statutorily-required criteria will your project/program address? [Check all that apply]:
Crime Prevention Neighborhood Safety Drug Abuse Education or Prevention
What neighborhood(s) or area(s) within the boundaries of Orange County will be impacted by your project or program?:

What age groups will participate in your project or program?:

Amount of funds requested:

Are there other sources of funding for your program or project?:
Yes No
Please list other sources of funding:

Agreement:
By checking this box, the Authorized Applicant Representative agrees that any funds awarded shall be used only for the purposes authorized by the selection committee. If selected for funding, the Applicant will be required to enter into an agreement setting forth the terms and conditions related to fund expenditures.

Awards Application