ORGANIZATION INFORMATION Organization: Program Name: Contact Name: Mailing Address (Street): City, State, Zip: Website: Make Check Payable to: USTA Organization Work Membership #: Home/Mobile Phone Are you a 501[c]3? Fax Tax ID # PROGRAM/Event INFORMATION (“X” ALL THAT APPLY) in New 1-3 4-6 years 7+ years existence: Target Youth (10 & Under) Junior (11-18) Collegiate (19-24) Audience: Adult (25-49) Senior (50 & up) Target Ability: Beginner Intermediate Advanced Facility Type: School(K-12) College or University Other (list): Public Park Diverse Group(s) Example: What is the cultural/race make-up of your team? Served and 50% 20% Asian American, 30% African American. Percentage Program Start Date: End Date: Hours/Week: Number of program participants: 2016 Actual: 2017 Goal: Number of tennis courts to be used: Number of sites to be used: Program Fee: $ / person Number of scholarships offered: Grant Amount Requested $
ORGANIZATION INFORMATION Organization: Program Name: Contact Name: Mailing Address (Street): City, State, Zip: Website: Make Check Payable to: Work USTA Organization Membership #: Home/Mobile Phone Are you a 501[c]3? Fax Tax ID # PROGRAM/Event INFORMATION (“X” ALL THAT APPLY) in existence: New 1-3 4-6 years 7+ years Target Audience: Youth (10 & Under) Junior (11-18) Collegiate (19-24) Adult (25-49) Senior (50 & up) Target Ability: Beginner Intermediate Advanced Facility Type: School(K-12) College or University Other (list): Public Park Diverse Group(s) Served and Percentage Example: What is the cultural/race make-up of your team? 50% 20% Asian American, 30% African American. Program Start Date: End Date: Hours/Week: Number of program participants: 2016 Actual: 2017 Goal: Number of tennis courts to be used: Number of sites to be used: Program Fee: $ / person Number of scholarships offered: Grant Amount Requested $