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2. County of Cumberland, Virginia
4. External Organization Funding Request Application
   Fiscal Year: 2022 (July 1,2021 - June 30, 2022)
6. Legal name of organization:*
   (Should be the same as IRS publication letter and supplied on IRS Form 990)
8. Address*
10. City*
11. State*
12. Zip Code*
14. Phone Number*
15. Fax Number*
17. Email Address*
19. Officer's Names*
20. Titles*
21. Phone #*
23. External Auditor*
24. Address:*
25. Phone #*
27. Funded Services will be provided:*

    1. Regionally

    1. in Cumberland County
28. Duration of Support:*

    1. One time
    2. 2-3 years

    1. Ongoing
30. Organization's Fiscal Year (e.g., July 1 - June 30)*
32. Number of Clients Served:
34. Time Frame:
36. July 1, 2020 - today
37. Total Clients Served:*
38. # of Cumberland County Citizens Served:*
40. July 1, 2019 - June 30, 2020
44. July 1, 2018 - June 30, 2019
48. Organization's Total Operating Budget:*
49. FY 2022 Funding Request from Cumberland County: $*
51. Please define your organization's mission.*
53. Please provide a description of the programs and/or scope of services you offer or intend to offer the citizens of Cumberland County.*
55. Please provide a detailed breakdown of how the requested funds from Cumberland County will be used.*
57. If your request for funds exceeds your request from last fiscal year, please give a detailed explanation for the requested increase.*
59. What additional funds are you requesting from other localities, state funds, private donations, etc? (This should also be included in your total operating budget)*
61. What will the impact be on your organization and the citizens of Cumberland County if funding is denied or is less than requested?*
Leave This Blank:


65. 1. Receive an email copy of this form.
66. Email address

    This field is not part of the form submission.

67. Submit

* indicates a required field