The PTSSD is only able to accommodate a maximum of three (3) grant requests per monthly meeting. Requests are scheduled in the order in which they are received by the Secretary of the PTSSD Board. The Board meets on the 3rd Wednesday of every month from 6:00-9:00pm from September – June. There are no meetings held in July or August.
Click on the title/format of the form you need to download…
Grant Request Form
Download this pdf: Grant Request Form, and open it on your computer. Fill in all fields, and answer all questions. Please use your digital ID to sign the application. If you do not have one, you can easily create one by clicking inside the signature box and following the prompts.
For your convenience the Grant Application is also available in Word
Co-Sponsored Grant Request Form
Download this pdf: Co-Sponsored Grant Request Form (or this Word version of the application), and open it on your computer. Fill in all fields, and answer all questions for Part A. Please use your digital ID to sign the application. If you do not have one, you can easily create one by clicking inside the signature box and following the prompts.
Next, forward the application to your Co-Sponsor, and have them complete and signPart B.
Once completed, all Forms and attachments can be e-mailed to
Katrina Mansfield at [email protected]
or mailed to:*
Penn Treaty SSD
702 N. 3rd Street
PMB 38
Philadelphia, PA 19123
*Kindly email [email protected] or leave message at 215-574-9274 if you send the application by post. Thank you -km.
Grant Agreement Form
An Agreement will be provided and signed at the time your organization receives your funds. It is available here for your advance review of the terms and conditions.
Grant Agreement Form (PDF) Co-Sponsored Agreement Form (PDF)
Grant Progress Report Form
All grant recipients are required to complete an interim (6 months) and final report (1 year) after receipt of their grant. Please choose the format you prefer and download the form from the links below.
Grant Progress Report Form (PDF) Grant Progress Report Form (Word)