Thank you for your interest! Please submit this form by 4 pm on Friday, April 25th, 2025. You may apply for both grants, though receiving both is not guaranteed.

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* 1. Lead Applicant Contact Name and Title

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* 2. Lead Contact Email

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* 3. Lead Contact Phone Number

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* 4. Lead Organization/School

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* 5. Lead Org/School Mailing Address

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* 6. Fiscal Agent (If using BEDF, please include BEDF number)

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* 7. If you have an existing BILL.COM account, please enter the account holder’s name and e-mail. Otherwise, please enter the contact you'd like to use for direct deposit of funds.

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* 8. Total Grant Amount Requested

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* 9. Grantee Type