Grant Application

Organization Name *

Project Name *

Mission (100 words or less) *

Agency Website*

Agency Facebook page

Additional Social Media

Mailing Address *

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

CEO/Executive Director First & Last Name *

Phone *

Email *

Primary Project Contact First & Last Name *

Phone *

Email *

Federal Employer Identification Number *

State of Florida Charitable Registration Number *

501(c)(3)? *
YesNo

County/Counties to benefit most from the proposed project *

Has the Organization received funding from the ASGC in the past? *
YesNo

If yes, please list the years and amount awarded.

If yes, has the organization submitted final reports for previously awarded grants?
YesNo

Number of Persons proposed to be served through the project. *

Will program participants be charged for services? *
YesNo

If yes, describe briefly.

Project Description - Briefly Describe Project (250 words or less)

Amount Requested *

Line Item Budget for which ASGC Funds are requested:

Please upload a line item budget for the total project, including items to be provided by other funding sources or in-kind items. The budget must account for all funds requested from the ASGC. If awarded the grant, the budget outline must be followed unless adjustments are approved in writing by the ASGC prior to incurring the expense.

Line Item Budget *

Supplemental Materials Required

Please upload the following in separate pdf documents:

Copy of IRS 501(c)(3) Designation Letter *

Copy of the first page only of the most recent IRS Form 990 filing *

Copy of current State of Florida Charitable Solicitation Registration *

List of current members of Board of Directors including email addresses *

Autism License Plate Marketing Section

The funds available through this grants process are generated through the sale of the Florida “Support Autism Programs” specialty license plates. Marketing outreach and communication help support our efforts to raise awareness and increase funding available for autism services. The following provisions and requirements are related to these efforts.

Funder Recognition

The Recipient of ASGC funds shall actively publicize and support the work of the ASGC through name and logo inclusion on all funded program materials, client and parent information and forms, banner displays and recognition in Annual Reports, newsletters and other forms of agency and/or program promotion. Recipient staff working in ASGC-funded programs shall be made aware of ASGC support through agency orientation sessions, staff meetings, and other employee communication strategies. Recipients of ASGC funds will also receive a “Press Kit” with templates for press releases, face book and twitter postings as well as other marketing materials which they will agree to use in the promotion of the Florida “Support Autism Programs” specialty license plate and the ASGC. Evidence of these efforts may be a factor in future ASGC funding recommendations.

Please complete this form by responding, where indicated.

1. Has your organization participated in assisting to market the Florida "Support Autism Programs" specialty license plate? *
YesNo

If yes, please describe.

If no, would you be willing to assist in marketing the Florida "Support Autism Programs" specialty license plate?
YesNo

2. Please provide any ideas you have to make more people aware of and encourage them to purchase Florida "Support Autism Programs" specialty license plates.