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Home
About
Services
Careers
Contact
Forms
ASF Info Form
ASF Detail Form
Home
About
Services
Careers
Contact
Forms
ASF Info Form
ASF Detail Form
ASF Detail Form
ASF Detail Form
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Name of the Organization (Legal)
*
Name of the Organization
Doing Business As (DBA)
*
Doing Business As
Year Original Facility Was Built
*
Year Original Facility Was Built
501(c)(3) (Requires a hard copy to submit grant application)
*
Yes
No
Federal EIN # (same as 501c3)
*
Federal EIN #
UEI number/registration through SAM.GOV website
*
UEI number/registration
Website / URL
*
Website Address
Address
*
Address Line 1
Address Line 1
Address Line 2
Address Line 2
City
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Zip Code
Municipality and County
*
Municipality and County
Organization type (religious, educational, medical, other)
*
Organization type
Mission Statement (500 Character or Less):
*
Mission Statement
Additional sites and locations (if applicable)
Additional sites and locations
Addresses for additional sites (also include building, Parking lot, Imam house etc…)
Addresses for additional sites
Head of the organization/Authorized Signatory
*
Head of the organization Name
Email
Email
Title
Head of the trganization Title
Phone #
Phone
Is your site historic?
Have you had a Security Assessment Vulnerability (SAV) completed?
Yes
No
If SAV not completed, have you done a facility self-assessment?
Based on your mission statement please summarize your organization’s ideology, beliefs and mission
Points of contacts( Including Project Manager)
*
Contact #1 Name (Project Manager)
Email
*
(Project Manager) Contact #1 Email
Phone
*
(Project Manager) Contact #1 Phone #
Contact #2
*
Contact #2 Name
Email
*
Contact #2 Email
Phone
*
Contact #2 Phone #
Contact #3
*
Contact #3 Name
Email
*
Contact #3 Email
Phone
*
Contact #3 Phone #
Have you had or aware any terrorist / bias incident within your county?
Do you have relationship with your local and county law enforcement?
Yes
No
Has your local law enforcement conducted a walk through in case for active shooter?
Yes
No
Have you ever applied for any of these grants
State
Fema
Other
If you have applied for the grants, When did you apply? What were the results?
How many members are in your congregation?
On average, how many people come to worship besides major holidays?
How many people attend services during your major Holidays’ celebrations?
What other services besides worship your organization provides to the community? (for example: soup kitchen, recreational, facility rentals, festivals..etc.)
Do you currently have the emergency operation plan (EOP), which covers all hazards in place?
Is your site a shelter for natural or manmade disasters?
Is your location used as a poll station?
Do you have a daycare or after school program on your site?
Yes
No
If you have a daycare or afterschool program on your site, How many children attend?
Do you have a private school on your site?
Yes
No
If you have a private school on your site, How many children attend? What are there grades?
Do you conduct religious classes/studies on your site? (weekend school)
What is the estimated size/square footage under your site?
What are your current security concerns?
How would you like to spend your grant money? (security cameras, exterior lights, fence, security film, exterior doors, locks, generators, PA system, portable radios etc…) list by priority
What are any additional concerns or comments you have?
Are you part of local interfaith group?
Form Completed By
Form Completed By Name
Signature
Clear Signature
Application Fee
*
Price:
$250.00
PayPal Commerce
*
PayPal Checkout
Credit Card
Card Number
Expiration Date
Security Code
Card Holder Name
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Billing Address
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Date
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Grants
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