New York State Commission on
National & Community Service

New York State Commission on
National & Community Service

Andrew M. Cuomo

Governor

Susan K. Stern

Commission Chair

Mark J. Walter

Executive Director

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Disability Inclusion National Service Mini-Grant

Program Name: Lead Agency Name:
Staff Contact Name Contact Address
First Name: Address Line 1:
Last Name: Address Line 2:
Contact Info City:
Phone: State:
Email: Zip Code:
National Service Programs Engaged:       
For AmeriCorps*State Programs ONLY Contract #: Program Year:

All applicants must address each of the following points in the Narrative Section:
1. Provide a basic overview of your national service program and how it serves your community;   
2. Describe the [proposed resource/service to be reimbursed and explain why the proposed expense/service is necessary to support your program (i.e.: outreach and recruitment, reasonable accommodations, and/or auxiliary services);   
3. Describe how the funding/resource will impact your program and in turn what benefits will be provided to the community as a result.   

 Budget Form

Support Expense Type Description and Calculation Total Requested
A. Project Personnel Expenses
B. Personnel Fringe Benefits
C. Travel
D. Equipement
E. Supplies
F. Contractual and Consultant Services
G. Other Supplies
H. Indirect Costs
BUDGET TOTALS: