Agency Application

"*" indicates required fields

Name of Organization*

Primary Contact*

First Last

Primary Contact Address*

Street Address Address Line 2 City State ZIP Code

County*

Primary Contact Email*

Primary Contact Phone Number*

Secondary Contact Name

First Last

Secondary Contact Email

Secondary Contact Phone Number

What is the Total Number of Touchpads Needed for all Locations?*

Locations for Distribution*

Location

Quantity of Touchpads

Create a new line using the (+) for each new location.

Touchpad Cost

Gift In-Kind Requested

List all Stakeholders Involved with Distribution

Contact Name

Title

i.e. NC Representatives/School District Superintendent/Health Department Director

How do you propose supporting each location and child?*

How and when do propose to register and distribute the Touchpads to qualified Pre-K students?*

What foundations in your community support early childhood education and development?*

Provide a brief statement indicating why you would like to partner with ApSeed:*

If selected, describe how you feel this will impact your community?*

Are you willing to collect and share data that would help ApSeed determine the level of success in your community?*

Yes

How did you hear about ApSeed?

Upload Cover Letter*

Drop files here or

Accepted file types: pdf, doc, docx, jpg, png, Max. file size: 25 MB.

Please upload a cover letter describing why your organization should be selected for an ApSeed Grant.