Places and Spaces Program Application

Applicant Name*

First NameLast Name
Applicant Email*
example@example.com
Organization Information
Organization/Group Name:*
Organization President/Leader:*

First NameLast Name
President/Leader Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
President/Leader Phone Number:*
Please enter a valid phone number.
Alternate Phone Number:*
Please enter a valid phone number.
President/Leader Email:*
example@example.com
Project Manager:*

First NameLast Name
Project Manager Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Project Manager Phone Number:*
Please enter a valid phone number.
Alternate Phone Number:*
Please enter a valid phone number.
Project Manager Email:*
example@example.com
Describe your organization or group (structure, goals, purpose). What is your experience in organizing neighborhood-focused projects, ability to plan, design and implement the project?:*

Project Information
Project Title:*
Project Location/Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Estimated Project Start Date:*

MonthDayYear
Date
Estimated Project End Date:*

MonthDayYear
Date
Amount Request (cannot exceed $100,000):*
Tell us about your project:*
Type of Project:*

Public SafetyOrganizational DevelopmentRecreational, Educational, and CulturalOther
Describe the goals of the project and how they will meet the needs of the neighborhood:*
Goals of Project:*

Improve quality of lifeBring people togetherImprove communication and partnershipsOther
Explain the process you used to plan the project:*
You must provide documentation that shows that appropriate input was obtained in planning this project. Please include letters of support from organizations involved in the project, minutes from board or organizational meetings where votes were taken or discussions were held concerning the project. Provide copies of flyers, emails, or letters demonstrating that all citizens, organizations, and groups who will be affected by the project were given ample opportunities to participate in the planning process. Upload those files below:
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List any additional involved partners or resources outside of organization:*
Name of Neighborhood Commissioner involved in the planning or outreach for project:*

First NameLast Name
What resources have you identified to support 100% the project? (number values only)*

For each Budget Item listed, please list and provide an explanation below: *

If you provided "Other Sources" as your funding, please list and provide an explanation below: *

Organization Information