Agency Grant Application

Please note all fields must be filled out before submitting.

Agency Name
Address	Lend a Hand will send checks to this address.
City
State
Zip Code
Job Title
Name
Phone Number
Email
First Name
Last Name
Address
City
State
Zip Code
Age
Senior? (65+ years old)
Gender
Number of Children
Spouse?
Total Number of Household Members
Veteran?
Disabled?
Purpose of Grant
Amount of Money Requested
Total Amount of Money Owed
Checks Should Be Issued to:	(exact name of check payee)
Account Number for Utilities or Other	(N/A if not applicable)
Situation	Briefly describe the situation and why the grant is needed.
Other Organizations	List any other organizations you are contacting for support.
Cover Letter	Please upload a PDF or similar file of your cover letter, on your agency's letterhead.

Reminder: Grants are made once in a lifetime per family or individual.

Brookline Grant