Short Application - Funding Requests $1,000 or less
Applicant Information
Organization Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name/Title of Requesting Leader
*
Project Manager/Leader (if different from above)
*
Phone Number
*
Please enter a valid phone number.
Fax Number
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Project
Title
*
Amount Requested $
*
Purpose
*
Goals and Objectives:
What is the target population?
*
What is the time period for fund use?
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Who else have you applied to for Funding?
*
Qualification Information (If startup project complete this section)
*
List the names, titles & qualifications of the individuals who will administer this project.
*
How does the applicant plan to evaluate the success of the project?
*
Organization Information
List the current officers and Board members of the applicant’s organization
*
For new applicants only: Please describe your organization including its history and financial information.
*
Funding Information
What other funder(s) has the applicant applied to for funding of this project?
*
What is the applicant’s current budget?
*
What is the total project budget?
*
I hereby certify that the statements contained in this application are true and correct and that this project proposal has met our Board's approval at a meeting held on:
*
Executive Director Title Signature
Date
*
-
Month
-
Day
Year
Date
Board Chair Signature
Date
*
-
Month
-
Day
Year
Date
Submit
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