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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.

Email *

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)