Thank you for considering Divas In Defense to empower you through our Passion For Protection. Please complete the application below for consideration of a full or partial grant from Divas In Defense to supplement our fee for a self-defense class/workshop.

Full Name:

First Name

Last Name

Email:

ex: myname@example.com

Phone Number:

ex: (555) 555-5555

Address 1:

Street Address

Address 2:

(Apt., Suite, Box, Unit, etc.)

City:

State:

AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY

Zip Code:

DOB:

EIN or Tax ID:

ex. xx-xxxxxxx

Social media presence and handle(s):

Facebook:
Instagram:
Snapchat:
Twitter:

Why do you need a grant?

Do you have a budget?

yesno

If Yes, what is it?

$

What class/workshop are you looking to attend?

Fierce & FabulousGirls Can Fight Too!On Her Own

By typing your name below, you authorize Divas In Defense Inc. to review your application and social media platforms.

Electronic Signature:

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