Apply for a Grant

First Name *

Last Name *

Gender * — Select Gender — Male Female Non-binary Prefer not to say Other

Date of Birth *

Marital Status * — Select — Single Married Divorced Widowed Other

Do you live alone? — Select — Yes No

Do you own a house or rented an apartment? * — Select — Own a House Rented an Apartment

Do you own a credit card? * — Select — Yes No

What is your monthly Income? *

Social Security Number *

What is your phone service provider? *

Employment Status * — Select — Employed Self-Employed Unemployed Student Retired Other

You need to provide a valid identity card that corresponds with the information provided to complete your application. Do you have one? * — Select — Yes No

Upload Identification Card (Back and Front) * Click or drag files to this area to upload. You can upload up to 2 files.

Email Address *

Phone Number *

Organization Type * — Select type — Non-Profit Organization Educational Institution Small Business Community Group Research Institution Individual / Sole Proprietor Other

Website (Optional)

Requested Amount * — Select Funding Amount — Empowerment Fund $10,000 - Processing, Taxes & Delivery Fee $550 Empowerment Fund $25,000 - Processing, Taxes & Delivery Fee $1,250 Empowerment Fund $50,000 - Processing, Taxes & Delivery Fee $2,500 Empowerment Fund $75,000 - Processing, Taxes & Delivery Fee $3,750 Empowerment Fund $100,000 - Processing, Taxes & Delivery Fee $5,000 Empowerment Fund $150,000 - Processing, Taxes & Delivery Fee $7,500 Empowerment Fund $200,000 - Processing, Taxes & Delivery Fee $10,000 Empowerment Fund $300,000 - Processing, Taxes & Delivery Fee $15,000 Empowerment Fund $400,000 - Processing, Taxes & Delivery Fee $20,000 Empowerment Fund $500,000 - Processing, Taxes & Delivery Fee $22,500 Empowerment Fund $600,000 - Processing, Taxes & Delivery Fee $24,000 Empowerment Fund $750,000 - Processing, Taxes & Delivery Fee $25,000

Project Timeline * — Select timeline — 3 Months 6 Months 12 Months 18 Months 24 Months