St. Louis Hills Special Business District Funding Requests
Name of project:
*
Timeline for project:
*
Location of project (address and/or specific location where project will take place):
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is this submitted on behalf of an organization?
*
Yes
No
Name of Applicant/Host Organization:
*
Contact:
*
First Name
Last Name
Contact Title:
Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Fax:
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Type of Organization - IRS Status (Tax ID Number):
*
FID NO.
If applicable, attach Articles of Incorporation, Bylaws:
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Attach a list of members of the organization's Board of Directors:
*
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Attach a list of organizational and project staff of the organization:
*
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Attach the most recent annual financial report for the organization and the budget for the upcoming year:
*
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Attach proof of good corporate standing (if applicable):
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Attach a description of the project:
*
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Liability/Medical Insurance?
*
Yes
No
If Yes, indicate insurance carrier - Note: St. Louis Hills SBD must be named additionally insured and provided a COI:
Indicate insurance contact:
Indicate insurance telephone number:
Please enter a valid phone number.
Format: (000) 000-0000.
Attach project budget with itemized categories of revenue and expenses:
*
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Amount of funding requested:
*
In dollars
Intended use of the funds:
*
Attach proof of any matching funds (equal or greater than amount request from the St. Louis Hills SBD):
*
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Please list all agencies that you have communicated with that would need to know about this project:
*
Please attach correspondence confirmation for all agencies that you have communicated with:
*
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Please include any permits that you may have to acquire (or have acquired) in order to complete this project:
*
How will this project benefit the St. Louis Hills SBD?
*
Have you received St. Louis Hills SBD Special Project Funding in the past?
*
Yes
No
If Yes, indicate the name and date of project and the amount received:
Would this project happen without the support of the SBD?
*
How do you measure the success of your project?
*
Submit
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