Vets.colorado.gov



5457190000DEPARTMENT OF MILITARY AND VETERANS AFFAIRSDivision of Veterans Affairs6848 S. Revere ParkwayCentennial, Colorado 80112Phone (720) 628-14802021-2022 VTF Grant Application Form Legal Name of Organization:285755270500118491015938500DBA (if applicable): 1905029400500Mailing Address (include physical address if different):49053753035300026670003054350047625031305500Phone: Fax: EIN:65722512509500Website: 197167512509500Organization Email Address:252412512700000Name of Authorized Representative: 253365012573000Title of Authorized Representative: 290512589535005524504318000Phone: Email:1905125908000VTF Grant Program Contact (person responsible for the day to day operation of program or services to be funded):9378957429500Contact Title: 27622501219200047625012192000Phone: Email:410527566040$00$118110075565$00$Amount of Request Amount Awarded: 2021-2021 VTF Grant Application Form page 1Organization Information952519113500Mission Statement:-952526924000Geographic Area Served (specific to this proposal):Tax Exemption Status:501(c)_______(Briefly) Describe what the grant will be used for: -190501841500By signing below, I certify that the information contained in this application is true and correct to the best of my knowledge and indicates an agreement to accept the terms and conditions of the grant award.Typed Name of Authorized Representative/Title Signature of Authorized RepresentativeDate2021-2022 VTF Grant Application Form page 25215890-13081000DEPARTMENT OF MILITARY AND VETERANS AFFAIRSDivision of Veterans Affairs6848 S. Revere ParkwayCentennial, Colorado 80112Phone (720) 628-1480 2021-2022 VTF GRANT APPLICATIONPROGRAM DETAILIdentify the primary geographic target area to be served:________________________________________________________________________Identify the number of veterans in the area and provide the data source:________________________________________________________________________Identify the needs of veterans in your service area: ________________________________________________________________________Identify the services you intend to provide: ________________________________________________________________________5092065-16891000DEPARTMENT OF MILITARY AND VETERANS AFFAIRSDivision of Veterans Affairs6848 S. Revere ParkwayCentennial, Colorado 80112Phone (720) 628-1480 2021-2022 VTF GRANT APPLICATIONPROGRAM DETAILIdentify the number of unduplicated veterans to be served: ________________________________________________________________________Identify other providers that provide services to veterans in your service area: ________________________________________________________________________Identify how your services fill in the “gaps.” How does your program collaborate with other services to avoid duplication? Include your relationship with your County Veterans Service Officer in your response. ________________________________________________________________________5454015-27241500DEPARTMENT OF MILITARY AND VETERANS AFFAIRSDivision of Veterans Affairs6848 S. Revere ParkwayCentennial, Colorado 80112Phone (720) 628-14802021-2022 VTF GRANT APPLICATIONPROGRAM DETAILWhat difference (impact, changes) will your program make in veterans’ lives? ________________________________________________________________________What is the total number of veterans (duplicated) you expect to serve? ________________________________________________________________________Identify the number of unduplicated (individuals) veterans served by your program during the previous calendar year. ________________________________________________________________________What services did your program provide in the previous year? ________________________________________________________________________5320665-24130000DEPARTMENT OF MILITARY AND VETERANS AFFAIRS Division of Veterans Affairs6848 S. Revere ParkwayCentennial, Colorado 80112Phone (720) 628-14802021-2022 VTF GRANT APPLICATIONPROGRAM DETAILWhat has been the impact of the services you have provided? (Previous grantees should use survey results. If you are not a previous grantee, explain how you determine the impact of your services)? ________________________________________________________________________Are you willing to participate in DMVA evaluation (surveys)? ________________________________________________________________________Attach a line item budget and budget narrative that clearly identifies estimated expenses, estimated numbers and purpose for funds. If applicable, attach a bid sheet from a dealer for vehicle purchase. Identify any other sources of funding to be utilized for the program. ................
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