Funding Request Form

March 5, 2025

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

Type of Funding Requested

Expense

Capital

Discretionary

Organization Name

Address

Apt Number

City

State

Zip

Tax ID #

Project Title

Purpose of project

Amount Requested

Executive Director/Project Director

First Name

Last Name

Confirm Email:

Phone Number

User Name

Assemblymember

Edward Gibbs

Assembly District 68

Funding Request Form