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 using the "submit" button 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 using the "submit" button BELOW.
*Denotes a mandatory response

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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 using the "submit" button 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 using the "submit" button BELOW.
*Denotes a mandatory response