Funding Request

NCKDSS Funding / Grant Request

Submit your request for board review. Board members will receive a secure review link after submission.

Requester Information

Name of Requester

Phone Number

County

Address 1

Address 2

City

State

Zip

Amount Requested

Date Funds Needed

Type of Grant

Family

Educational

Medical

National Convention

Title of Request

Description and Details of Request

Attach Supporting Documents (optional)

PDF, Word, Excel, JPG, or PNG. Maximum 8 MB.