Grant Application New

City of St. Matthews Application of Funding

3940 Grandview Ave

St. Matthews KY 40207

(Please type or print)

Submissions must be made by May 1st for consideration for the next fiscal year.

Name of organization group or entity requesting funds:

Total amount of funding required for the year or project: $

Amount of funding requested from City of St. Matthews: $

Does the applicant agree to provide the most recent budget or tax statement?

YesNo

Specify how the funds will be used:

Has the City of St. Matthews provided funding, for any purpose, within the past two (2) years?

YesNo

If yes provide details:

The undersigned, the authorized officer or agent of Organization
, hereby certifies that organization is a not-for-profit entity, that the proceed of any distribution from the City will be solely for the purposes set forth herein, and further that Organization does not discriminate against any person or entity on the basis of race, religion, sex, or national origin.

Signature*

Date

Print Name

Mailing Address

City, State, Zip

Phone Number

Email Address

example@example.com