Grant Application (General) – Colon Cancer Coalition

Application Date*

Name*

Organization*

Your Email*

City, State*

Phone Number*

Website*

Have you received funding from the Colon Cancer Coalition in the past?*

Yes
No

What year did you receive funding?

If you have received funding in the past, have you submitted your Grant Recap Form?

Yes
No

If no, please complete the form here.

New applications will not be considered without a recap completed for previous funds.

Nearest Colon Cancer Coalition Event City*

If "NONE/OTHER" - where are you located?

Amount Requested*

Please do not use dollar signs.

Purpose of Grant*

Select all that apply.

Colorectal Cancer Screening
Public Awareness and Education
Provider Awareness and Education
Patient Support
Research

Populations Served by Grant*

Ethnicities Served by Grant*

Select All
Asian/Pacific Islander
Black/African American
Hispanic
American Indian/Alaska Native
White
Other, please note in the project decription

Important information about stool-based testing.

Applicants requesting funding for stool-based colorectal cancer screening must also indicate how patients with a positive stool test will be navigated to follow-up colonoscopy and ultimately colorectal cancer treatment, if required.

Description of Organization and Specific Project to be Funded*

Summary of the organization and details about the project. 500 characters max - attach supporting documentation if necessary.

Supporting Documentation (if needed)

Max. file size: 10 MB.

Proposed Use of Granted Funds*

Specific use of the funds, i.e.: video production, printing of awareness related materials, fund screening programs, etc. Include locations and names of outside vendors or providers as well as contact information for persons at these locations. Application must include a line item budget for the funded program.

Successful applicants will be expected to play an active role in the Colon Cancer Coalition event in your area. Please mark all ways your organization will be able to partner with the Colon Cancer Coalition to support and promote your partnership.

Publicly acknowledge the grant through:

Social media posts and engagement
Press release from your organization
Blog story or other acknowledgement on your website
Inclusion in newsletter or other communication to your supporters

Be an active partner in the local event through (please choose minimum of four to be considered):

Forming a team to participate in the event
Share local Colon Cancer Coalition event with your sponsors and supporters on your website and through social media
Having a table display at the event including showcasing how the funds were used in the community
Assist the local event director and help recruit volunteers
Help promote the event to colon cancer survivors in your community

Please submit a line item program budget clearly identifying requested funds.*

Max. file size: 3 MB.

Please submit a recent W9.*

Max. file size: 3 MB.

Please submit any additional supporting documentation.

Max. file size: 3 MB.

Checks should be made out to:*

And mailed to:*

Attn:

EIN Number*

Where can we find you on social media?

Include URLs or handles for Facebook, Twitter, Instagram, LinkedIn, TikTok, and YouTube as appropriate.

Who referred you to complete this grant application?

If you were not referred, please indicate how you found us.

Grant Application

Get creative. We are looking for out-of-the-box thinking that will:

Successful applicants will be expected to:

Important information regarding use of granted funds:

Grant Application