AFSF Application | Riverside County District Attorney

Applications must include:

A completed/current W-9 form
IRS 501(c)(3) Determination Letter (if applicable)
a letter on your organization's letterhead explaining how your organization qualifies for this special fund grant program and why it should be selected.

PLEASE NOTE: The word count for some fields are limited to 300 words or less.

Date

Organization

Name & Title

Office Phone

Cell Phone

Physical Address

Mailing Address

Amount Requested $

Does organization currently offer intervention?

Name of Specific Intervention Program

Previously Received Grants from Riverside County

If so, Indicate the Year and Exact Amount

In the last year that you were awarded money, how was that money spent?

Year the intervention program was started

Current Annual Operating Budget $

The target audience for this program

Age Range of Program's Participants

Number of Participants Assisted

Program Summary

Detail how your program combats drug abuse and/or divert gang activity

Specify how the requested funds will be spent on the intervention program

Will this grant allow you to expand the program?

If Yes, how many additional participants are expected to receive services? Describe your plans for expansion.

Do you receive direct referrals from a government agency?

If Yes, from what agencies do you receive direct referrals?

If No, how do school-age children get into your program?

Is your program limited to at-risk youth?

If no, please describe all the types of groups your agency serves.

Do you charge children or their families for the services you provide?