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Equipment Grant Application - Massachusetts Residents Only
NOTE: Please complete the entire form. All items are required.
Grant Request
This grant request is for
A Team or Program
An individual girl
If Grant is for an Individual, please enter name
What percentage of the girls in the program are low-income or homeless?
Applicant Information
Sport/Physical Activity
Baseball
Basketball
Boxing
Cheerleading
Cycling
Dance
Double Dutch
Fitness/ Exercise
Field Hockey
Football
Golf
Gymnastics
Hiking/Climbing
Ice Hockey
Karate/Martial Arts
Lacrosse
Recreation for young girls
Rowing
Running
Skating
Skiing
Soccer
Softball
Surfing
Swimming
Tennis/Racquet Sports
Track & Field
Volleyball
Other Activity: ______
First Name
Last Name
Title
Name of School/Program
School/Program Street Address
City
State
- None -
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Marianas Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Primary Phone
Email
Principal/Director Name
Principal/Director E-Mail
Website
Program Information
Program Name
Is this a New Program?
Yes
No
If no, how long has it been in existence?
Season/Program Start Date
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2021
2022
2023
2024
2025
Season End Date
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2021
2022
2023
2024
2025
If Co-Ed Program - Number of boys in program
Number of girls in program
Number of times per week training
Number of games/matches played per week in season
Demographics of girls in program: (Please provide number for each category)
Asian
African American
Latino(a)
White/Caucasian
Other Population
Age Information
Number of Girls Ages 1-4
Number of Girls Ages 5-7
Number of Girls Ages 8-10
Number of Girls Ages 11-13
Number of Girls Ages 14-16
Number of Girls Ages 17-18
Number of girls with disabilities you serve
How many girls are participating in this activity for the first time
Please list the top three towns/neighborhoods you serve
Equipment Request
Item Request #1
Quantity
Exact Size/Style/Color/Brand
Enter Item details, or submit URL link to specific product web page
Est. Cost/Item
Item Request #2
Quantity
Size/Style/Color/Brand
Enter Item details, or submit URL link to specific product web page
Est. Cost/Item
Item Request #3
Quantity
Size/Style/Color/Brand
Enter Item details, or submit URL link to specific product web page
Est. Cost/Item
Item Request #4
Quantity
Size/Style/Color/Brand
Enter Item details, or submit URL link to specific product web page
Est. Cost/Item
Please list in detail how the item(s) will be used to create or improve sports or physical activity opportunities for girls and why the item(s) is needed:
Leave this field blank
Grants & Scholarships
Equipment Grant Application
Program & College Showcase Scholarship Application
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