EC Vending Machine Grant Application

Please fully complete this application. Additional guidance is available: https://wsac.wa.gov/sites/default/files/FY2024.ContraceptionVendingMachineGrantGuidance.pdf

Applications will be accepted until 5:00pm, March 1, 2024. Complete applications will be reviewed on a rolling, first come/first served basis. Grants will be awarded in order of submittal of complete and acceptable applications, based on the date/time stamp of submittal, until all funds are exhausted. WSAC encourages earliest possible submission for best chance of receiving available grant funds.

1. What is your institution? *This question is required.

	Institution Name
	Address
	Title
	Email
	Phone number

2. Who is your Project Point of Contact?

	First Name
	Last Name
	Title
	Division
	Email
	Phone number

3. Who is your Grant Signatory (the person who would sign the contract for your institution)? *This question is required.

	First Name
	Last Name
	Title
	Email
	Phone number

EC Vending Machine Grant Application

Contact information