Contact Information

Please use your address, phone, and email when filling out the fields below.


The contact information provided in this section will be considered the main point of contact for this application.

Confirm Email*

Grant Application

Please complete all fields below. Contact with questions.

Name of Program/Project
Amount Requested (Maximum of $500)*
Project Director Name
Project Director Email
Executive summary of the program/project (limit 500 words):
Who will your program/project directly impact?*
How will your program/project benefit your community (limit 500 words)?*
Please list all communities your program/project serves:
How will you measure the success of this program/project?
How will you use the funds?
Project Start Date (mm/dd/yyyy)
Project End Date (mm/dd/yyyy)
Program/Project Budget
What are your strengths related to this program/project (limit 500 words)?
List other organizations you're partnering with for this program/project:
Why does the community need this program/project (limit 500 words)?
Are there opportunities for Advia employees to volunteer with your program or organization?


Please provide two references that the Advia Foundation can contact. These can be other organizations that are assisting with the project or professional references. At a minimum, include name, phone number, email address and business/organization name.

Additional Comments


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