Test - Florida Autism License Plate

Section 1: Organization Eligibility & Contact Info

Organization Name

Federal Employer Identification Number

501(c)(3)?

State of Florida Charitable Registration Number

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

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Copy of current State of Florida Charitable Solicitation Registration

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Agency Website

Agency Facebook page

Additional Social Media

Mailing Address

Address Line 2

City

State / Province / Region

Zip / Postal Code

Section 2: Key Contacts

CEO/Executive Director First & Last Name

Phone

Primary Project Contact First & Last Name

Phone

Section 3: Organizational Background

Mission (100 words or less)

Organization’s Annual Operating Budget- enter amount

Section 4: Funding History

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

If yes, please list the years.

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

Section 5: Project Proposal

Project Name

County/Counties to benefit most from the proposed project

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

Number of Persons proposed to be served through the project.

Will program participants be charged for services?

If yes, describe briefly.

Amount Requested

Section 6: Project Budget

Please upload a line item budget for the requested 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

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Section 7: Supplemental Attachments

Please upload the following in separate PDF documents:

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

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List of current members of Board of Directors including email addresses

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Section 8: Autism License Plate Marketing Section

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

If yes, please describe.

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

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.