2. Applicant Information

   Please provide applicant information for the Community Engagement Grants Program.

4. Full Name*
6. Address*
8. City*
9. State*
10. Zip*
12. Phone Number*
13. Email Address*
17. Organization Details

    Please provide information regarding your organization.

19. Legal name, DBA, or other name your organization may be known as*
21. Organization Filing Status (S-Corp, LLC, etc.)
22. Organization EIN Number
24. Organization's Website (if applicable)
25. Date organized or incorporated*
    Date organized or incorporated
27. Please list all grants received by your organization in the past five years.*
31. Fiscal Agent Information

    Please provide information regarding your fiscal agent.

33. Please check the box below if your Fiscal Agent is the same as your Organization.

    1. Same as Organization
35. Full Name/Organization Acting as Fiscal Agent*
36. Organization Acting as Fiscal Agent EIN Number*
38. Address*
40. City*
41. State*
42. Zip*
44. Phone Number*
45. Email Address*
47. By checking this box, you verify that this organization agrees to act as a Fiscal Agent for this year's Community Engagement Grant Program on behalf of the applicant, and that the Fiscal Agent possesses a Federal EIN and a checking account.*

    1. Agree
49. Are you AAA certified?*

    1. Yes
    2. No

    You can apply for Affirmative Action Assurance (AAA) certification online.

53. Project Information

    Please provide information regarding your project.

55. What is your project's name?*
57. Please provide a brief description of your project.*
59. Choose the City focus area that the project best belongs to.*
    -- Select One --Neighborhood IdentificationLeadership EmpowermentSafety Opportunities and EducationEnvironmental EnhancementsHealth and Wellness EngagementNeighborhood and Community InnovationOther

    • Neighborhood Identification: Place making through the creation or enhancement of assets that  are a source of neighborhood pride and identity.
    • Leadership Empowerment: Training neighborhood leaders or teams, and developing skills, for neighborhood governance or action.
    • Safety Opportunities and Education: Equipping the neighborhood with knowledge or tools to  prevent, prepare for, confront, or respond to incidences of crime or danger.
    • Environmental Enhancements: Protecting water and energy resources, and native plants, or creating garden space in your neighborhood.
    • Health and Wellness Engagement: Increasing access to nutritious food, physical or mental fitness opportunities, or health education.
    • Neighborhood and Community Innovation: Unique projects that bring neighbors together, solve a problem, or celebrate neighborhoods.
61. If the City focus area you chose above is "Other", please explain.*
63. Describe how your neighborhood/residents will benefit from this project.*
65. Is this a new, existing, or changed project?*

    1. New
    2. Existing
    3. Changed
67. How will you measure the project's success?*
69. How will you communicate the project's outcome with the residents after completion?*
71. How will the project be maintained and sustained after funds from the Community Engagement Grant are expended?*
73. Please explain your proposed project’s timeline to completion. Any grants distributed by the City of Dayton must be expended by November 27, 2026. (2,500 character limit)*
75. Petition

    Please attach your petitions document with signatures. If you have not yet obtained petitions, you can download and print this example document to begin the process.

79. Budget/Funding

    Please provide information regarding your project's budget/funding.

81. Community Engagement Grants Budget Workbook*

    Please download, complete, and upload the Community Engagement Grants Budget Workbook.

83. What is the amount of funding requested?*
85. Does this project have volunteer and/or in-kind funding? If yes, please provide the amount.*

    1. Yes
    2. No
87. What is the amount of volunteer and/or in-kind funding?*
89. Has this proposed project been partially funded through any other City, State, Federal, or private funding process? If yes, please provide the amount.*

    1. Yes
    2. No
91. What is the amount of partial funding?*
93. What is the total project cost?*
95. What are the specific outcomes and accomplishments this project will achieve? (500 character limit)*
Leave This Blank:


97. 1. Receive an email copy of this form.
98. Email address

    This field is not part of the form submission.

99. Submit Submit and Print

* indicates a required field