Grant Application

After completing the Cover Sheet Information form, please fill out the form below to complete your grant application.

Grant Application

2024 Grant Application
Have you completed the Grant Cover Sheet Information Form?

If you have not yet completed the Grant Cover Sheet Information form yet, you will not be able to complete this application. Please Click here to complete the Grant Cover Sheet Application first.

Contact Person
Contact Person

Proposal Narrative

Please provide your organizations information to include: number and composition of staff and volunteers and number of ambulances, carts, administrative vehicles, etc.
(e.g. model, type) and quote of the item.

Required Attachments*

  • Current Organizational Budget
  • IRS 501 (c) (3) Determination Letter
  • Most recent annual financial report (audited or unaudited)**
  • Most recent IRS Form 990
  • Current Year Financial Statement
  • Board/Officers and Staff listings
  • Evidence of accreditation, licensing, etc. if applicable
  • Informational materials (e.g.: quote of the item being requested)
  • EMS MOU if you are requesting funds for an insurable asset
  • Please contact Gina Benefiel at to confirm which documents you need to submit or re-submit.

    ** A current report is still required for extended grant deadline.

Maximum file size: 268.44MB