Application Form

All grantees must meet the following criteria:

  • Must provide assistance to men and women directly or indirectly impacted by drugs and alcohol
  • Must be located in Southern California
  • Must have 501(c)(3) tax-exempt status
  • Must have at least 10 years in operation
  • Must have an operating budget of less than $1.5M

* Denotes required fields


Organization Name: *

Are you qualified as a 501(c)(3) tax-exempt status? *
 Yes No
Please attach proof of tax status

Organization Mission Statement: *


Address: *

Address 2:

City: *

State: *

Zip Code: *

Phone #: *

Email: *


Years in Operation: * (10+ years required)

2015 Operating Budget: * (Less than $1.5M required)

Grant Amount Request: *

Summary of Request: *

Executive Director or Board President: * (please input full name)

Please check the box below *