Funding Request Form

July 18, 2024

Complete all fields of the form below and a member of Assembly Member Cunningham’s office will respond to follow up within three to five businesses days (excluding holidays).

Title

First Name

Middle Initial

Last Name

Suffix

Phone Number

Confirm Email

Address

Address Line 2

Apt Number

City

State

Zip

Type of Funding Requested:

Expense

Capital

Organization Name

Address

Apt Number

City

State

Zip

Phone Number

Tax ID #

Project Title

Purpose of project

Amount Requested

Executive Director/Project Director

Address

Apt Number

City

State

Zip

Phone

Email address

Confirm Email:

If fiscal conduit needed

Administering Organization

Address

Apt Number

City

State

Zip

Phone

User Name

Assemblymember

Brian Cunningham

Assembly District 43

Funding Request Form