Please fill out this application form to be considered for the Lancaster & Rose Jumpstart Fund.

Contact info First name:
Last name:
Phone #:
Email:
Organization:
City:
State:
Describe the impact COVID-19 has or had on your nonprofit
What are the current economic, organizational, staff or program issues you need Jumpstart Fund assistance with?

Do you understand this funding is not a grant, but discounted and/or donated services from Lancaster & Rose?

Yes
No

How did you hear about Lancaster & Rose?

Current or Past Client Referral
Client's Name: Personal Referral
Referral's Name: Lecture/Seminar
Company or Organization
Company/Organization Name: Online Avenues