Grant Name

DATE SUBMITTED

Submitted by

email

Phone Number

PROJECT ABSTRACT

STATEMENT OF NEED

Program Description

GOALS & OBJECTIVES

TIMELINE & Projected Dates

BUDGET OVERVIEW (Item Description, Price, Quantity)

BUDGET TOTAL

UPLOAD A 2 MINUTE VIDEO OF THE FEMALE FOUNDER UPLOAD A 2 MINUTE VIDEO OF THE FEMALE FOUNDER

UPLOAD PITCH DECK UPLOAD PITCH DECK

1. I hereby declare that the information given in this application is true and correct to the best of my knowledge and belief. I am a Female Founder with at least 35% equity in my company. 1. I hereby declare that the information given in this application is true and correct to the best of my knowledge and belief. I am a Female Founder with at least 35% equity in my company. YES NO

2. I also certify that my company will remain at least 35% women owned during the duration of the grant. 2. I also certify that my company will remain at least 35% women owned during the duration of the grant. YES NO

SIGNATURE OF APPLICANT

DATE