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Judy Housley Safety Partners Grant
Grant Application – Date Sensitive
Contact Person:
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Contact Person Email:
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Contact Person Title:
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Participant City (or Agency) Name:
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Street/PO Box Address:
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City
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Zip Code
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Contact Person Phone Number:
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No. of Full Time Employees in City/Agency:
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No. of Full Time Employees Affected by this Purchase:
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The City/Agency desires to purchase the following:
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Justification for the needed purchase MUST BE provided, indicating the departments or function areas that will be affected. One grant application, per member, per year. DO NOT send multiple applications for several departments.
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Estimate #1 Calculated TOTAL:
ELIGIBILITY TIMEFRAME: Purchases MUST BE made between July 1, 2024 and April 1, 2026.
Name of Approving Supervisor
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By submitting this Grant Application, I verify that all information is correct. Please only click the submit button once. If you do not receive a confirmation email within 15 minutes of submitting your application, please contact Tahtia Mitchell at TMitchell@PEPartners.org.