To submit this form you do not have to sign in or create a Form Center account (above. However, you will have to complete the form in its entirety without the option to save your progress unless you do create an account.
Use this link for instructions about how to create a Form Center account. Creating an account will enable you to save your progress while filling out the form.
Use "N/A" if agency doesn't have a website.
These summaries will be appearing on jacksoncountycombat.com. Therefore, it is important that they be written in third person, using the program's and agency's name. Summaries written in the first person ("we," "our," etec.) can lead to confusion in that visitors to the site might believe that COMBAT is directly operating your program.
This is brief summary of your program (limit 1,000 characters) is for use on our website index pages, where space is limited.
There is no character limit for the detailed description you can provide here. You can likely take the description from your fundng application, though be sure to edit accordingly to eliminate any first-person references.
This information will be published on the COMBAT website.
Include the name of school, church, community center, etc. Also list specific phone for that location if different than the contact number provided above.
Irving Elementary School
505 N. Elm Street, Kansas City, MO 64106
This information will not be published on our website, but email addresses will be added to our providers list for communications from COMBAT.
Director, Executive Director, President, etc.
By typing your name in the "Signature" box below, you acknowledge that this "electronic signature" is valid to the same effect of a traditional handwritten signature.
This field is not part of the form submission.
* indicates a required field