Equipment Grant Application - Massachusetts Residents Only

NOTE: Please complete the entire form. All items are required.

Grant Request

This grant request is for: *

A Team or Program

An individual girl

If Grant is for an Individual, please enter name: *

Are the girls in the program or individual girl low-income or homeless?: *

low-income

homeless

Applicant Information

Organization / School: *

Sport/Physical Activity: *

First Name: *

Last Name: *

Title: *

Address: *

City: *

State: *

Zip Code: *

Primary Phone: *

Email : *

Website: *

Program Information

Program Name: *

Is this a New Program?:

Yes

If no, how long has it been in existance?:

Season/Program Start Date: *

Season End Date: *

Number of girls in program: *

Number of times per week training: *

Number of games/matches played per week in season: *

Demographics of girls in program: (Please provide number for each category)

Asian: *

African American: *

Latino(a): *

White/Caucasian: *

Other Population: *

Age Information

Number of Girls Ages 1-4: *

Number of Girls Ages 5-7: *

Number of Girls Ages 8-10: *

Number of Girls Ages 11-13: *

Number of Girls Ages 14-16: *

Number of Girls Ages 17-18: *

Number of girls with disabilities you serve: *

How many girls are participating in this activity for the first time: *

Please list the top three towns/neighborhoods you serve: *

Equipment Request

Note: If requesting more than one item please list items in order of priority to program or girl.

Item Request #1:

Quantity:

Size/Style/Color/Brand:

Est. Cost/Item:

Item Request #2:

Quantity:

Size/Style/Color/Brand:

Est. Cost/Item:

Item Request #3:

Quantity:

Size/Style/Color/Brand:

Est. Cost/Item:

Item Request #4:

Quantity:

Size/Style/Color/Brand:

Est. Cost/Item:

Please list in detail how the item(s) will be used and why the item(s) is needed: *

Baseball
Basketball
Boxing
Cheerleading
Cycling
Dance
Double Dutch
Fitness/ Exercise
Field Hockey
Football
Golf
Gymnastics
Hiking/Climbing
Ice Hockey
Karate/Martial Arts
Lacrosse
Recreation for young girls
Rowing
Running
Skating
Skiing
Soccer
Softball
Surfing
Swimming
Tennis/Racquet Sports
Track & Field
Volleyball
Other Activity: ______