ECA SoCal 2019 MiniAward Application Form

Reminder: Applications must be submitted by 11:59pm PDT on Friday, March 29, 2019.

If you have any questions, please contact us at socal@earthquakecountry.org.

To apply for a mini award, please use the form below. Fields marked with " * " are required.





General Information


Name of Agency, Business, Association, or Organization*



Mission or Function of Your Agency, Business, Association, or Organization*



Contact Information

Name:*


Title:
Organization:

Mailing Address:
(2 lines, if needed)

City:
 State:   ZIP:*
Phone number:
E-mail address:*

Web site:



Program/Project Information


Program/Project Name*



Will your funding be used to support an existing project or create a new project?*
existing     new


Please describe the program/project (be as detailed as possible; how will the purchases made improve earthquake safety and resilience?)*



Who will this funding benefit?*



How will you evaluate the impact of this funding on your program/project?*



Expense Information

$500 Pre-Identified Packages

Choose one of these 11 package options (details are on the Mini Awards information page), or you can propose other items to be purchased:

Details of each of the following options are in our 2019 ECA Mini Award Options Catalog.

“Secure Your Space” Packages (3 separate $500 options)

    Secure a School Kit
    Secure a Community Organization or Small Workplace Kit
    Secure 10 Living Spaces Kit

“Plan to Be Safe” Packages (5 separate $500 options)

    500 Map Your Neighborhood “shingle” workbooks
    5000 Staying Safe Where the Earth Shakes booklets
    350 Foreshock brochures
    500 Rocket Rules Earthquake Adventure books
    ShakeOut Awareness Materials

“Organize Disaster Supplies” Packages (3 separate $500 options)

    Community Organization / Small Workplace Supplies for 20 people
    School Supplies for 10 classrooms
    Individual Supplies Kits for 20 people

Please add any comments or questions you may have about the options you have chosen, which we will contact you to discuss. This may include if you would like to receive double the quantity of one of the options (based on the case you make for the project you suggest).


OR, create your own package by providing an estimated budget (up to $1000) for items or services to be purchased, and how you have determined the cost. If you have have a quote from a vendor this can be emailed to socal@earthquakecountry.org.*