Valerie's Community Grant Program Application
This program issues microgrants for individual community residents who need financing for projects that would benefit Liberty Wells. The purpose of this program is to encourage positive actions and programs that have a positive impact on the overall community by making it a safer, more connected, and engaging neighborhood.
Recipient / Grantee Details
Name
*
First Name
Last Name
Company Name (if applicable)
Email
*
example@example.com
Phone Number
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name and contact information for co-applicants
Project Details
Description of the Project
*
Please provide, in detail, the scope of your project including start and completion dates. If you plan to do the work yourself or will employ contractors etc. Feel free to include any supporting documentation. Maps, copies of contractor paperwork or anything that makes the proposal more understandable. You can upload supporting documents at the end of this application.
Purpose of the project: How will this project benefit the larger Liberty Wells Community?
*
Amount Requested: Indicate your donated labor if any. Donated labor does not reduce the grant amount. If anything, it enhances the chances of approval.
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Include any supporting documents or image examples to help substantiate or clarify your request.
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Follow Up Summary
By signing below, I hereby certify that I will follow up with Liberty Wells Community Council after the completion of the project and will contact them with a follow up summary at LWCCSLC@GOOGLEGROUPS.COM
Prepared By
*
First Name
Last Name
Date Signed
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: