Short applications ($200 or less) are accepted NO MORE than 3 months in advance of the project start date.

Please complete the following application form and then click "Submit Application" at the bottom of the page.

Name of Organization and/or Project: 
Timeframe of Proposed Project From:To:
Amount Requested:                          $Applying for more than$200? Complete our full application.

Contact Name
Address:         
Address 2:      
Telephone:      
Fax:                
Email:             

Have you previously requested a grant from The Connie Fund?Yes   No

Please give a brief overview of your project:


Detail the population your project will benefit. Please estimate how many people will be affected by this project and in what manner they will benefit from this project.

Which counties will be affected by your project? Check all that apply.
Antelope
Boone
Madison
Pierce
Platte
Stanton
Wayne

Detail the funds and/or in-kind support currently available for your project.


Budget detail (if appropriate):