Funding Information Center (FIC) Request Form

OUR SERVICES ARE LIMITED TO TEXAS RESIDENTS ONLY

Thank you for your request for a funding/grant search from the Texas Department of State Health Services Funding Information Center (FIC).
Please note that FIC services are limited to clients in Texas.

Name:

Email:

City:

ZIP Code:

County:

Phone:

Type of Funding Needed (select one):

Private Funding

Public Funding

Is this a 501(c)(3) non-profit?:

Yes

Please list topics or subjects that you are requesting funding information from the FIC:

For what purpose will this funding be used? (Please provide specific information):

In what city or county will this funding be used? If seeking state-wide funding, please reply 'state-wide':

Have you received funding previously?:

Yes

If so, who provided funding? Please provide the name of each previous funding entity:

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Math question

3 + 7 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

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