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Youth Activity Fund Request

Please complete the following application. If you need assistance, or for a paper application, please contact the Community Support Liaison at (508) 237-7042.

Once your application is received, it will be reviewed and you will be contacted within 48 hours.

Grants are available on a rolling basis. You may apply and be awarded funds more than once.

Contact Information

Youth Participant's Name

First Name

Last Name

Parent's Name (if applicant is under 18 years old)

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Phone Number

Please use your preferred, best number to call.

Verify Email

Language Preference

Identify your language preference if different than English.

Youth Participant Date of Birth

MMDDYYYY

Briefly describe the program / camp / activity in which you are interested:

Please provide the amount requested for the program / camp / activity in which you are interested:

Certifications

I/We certify that all information furnished in this application for youth activities is true and complete to the best of my/our knowledge.

Yes

Youth Participant's E-Signature

Please print your full name.

Date

(mm/dd/yyyy)

Parent's E-Signature (if applicant is under 18 years old)

Please print your name.

Date

(mm/dd/yyyy)