Grant Application Form

New Start Grant Application

IF YOU HAVE NOT READ OUR NEW START GRANT APPLICATION GUIDELINES, PLEASE DO SO NOW.
APPLICATIONS MUST BE SUBMITTED BY A LICENSED SOCIAL SERVICE AGENCY CURRENTLY PROVIDING SERVICES TO THE CLIENT.
WE DO NOT ACCEPT REQUESTS FROM INDIVIDUALS.

COMPLETE Each of the following questions in full AND SUBMIT THE FORM BELOW.
*Denotes a mandatory response

* Indicates required field

Client Name or Initials *

First

Last

Agency Name *

Case Manager/Counselor Making Referral *

First

Last

Email *

Phone Number *

Has the applicant/client received a New Start Program grant in the past? *

Yes No

Does the applicant/client currently live in Western North Carolina? *

Yes No

New Start Program is a "last resort" fund. We ask that other sources of funding for this need be explored before submitting a request. What other local agencies have been contacted for assistance regarding this need? Please list below. *

Please tell us about your agency and your role in the client's situation. *

Is the client making behavioral changes and does she have in place specific plans for a "new start" in her life? *

New Start grants are not intended for use as a "stop gap" measure. We ask that a woman be ready to sustain her New Start before applying for a grant. Does the individual have the necessary support in place so she will be able to sustain her new start? Which agencies or agency will continue to provide support for her? *

One-time grants (per recipient) are available for the amount of need up to $600. Please ensure that you indicate the correct total amount you are requesting below and, if possible, please provide name, address and phone number of vendor. (Reminder: Checks are made payable to the vendor for their service, not the individual.) *

Submit

New Start Grant Application

IF YOU HAVE NOT READ OUR NEW START GRANT APPLICATION GUIDELINES, PLEASE DO SO NOW.
APPLICATIONS MUST BE SUBMITTED BY A LICENSED SOCIAL SERVICE AGENCY CURRENTLY PROVIDING SERVICES TO THE CLIENT.
WE DO NOT ACCEPT REQUESTS FROM INDIVIDUALS.

COMPLETE Each of the following questions in full AND SUBMIT THE FORM BELOW.
*Denotes a mandatory response

Home

Support Womansong

Contact Us

New Start Grant Application

IF YOU HAVE NOT READ OUR NEW START GRANT APPLICATION GUIDELINES, PLEASE DO SO NOW.APPLICATIONS MUST BE SUBMITTED BY A LICENSED SOCIAL SERVICE AGENCY CURRENTLY PROVIDING SERVICES TO THE CLIENT.WE DO NOT ACCEPT REQUESTS FROM INDIVIDUALS.

​COMPLETE Each of the following questions in full AND SUBMIT THE FORM BELOW.​*Denotes a mandatory response

Home

Support Womansong

Contact Us

IF YOU HAVE NOT READ OUR NEW START GRANT APPLICATION GUIDELINES, PLEASE DO SO NOW.
APPLICATIONS MUST BE SUBMITTED BY A LICENSED SOCIAL SERVICE AGENCY CURRENTLY PROVIDING SERVICES TO THE CLIENT.
WE DO NOT ACCEPT REQUESTS FROM INDIVIDUALS.

COMPLETE Each of the following questions in full AND SUBMIT THE FORM BELOW.
*Denotes a mandatory response