Grant Application Payette Lakes Progressive Club

Organization Information

Organization Name*

Organization Website

Organization Contact Name*

Organization Phone Number*

Area CodePhone Number

Organization Email Address*

Organization Mailing Address (grant recipient funds will be mailed to this address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Grant Writer Contact Information (if different from Organization Contact Information above)

Grant Writer Name

Grant Writer Phone Number

Area CodePhone Number

Grant Writer Email Address

example@example.com

Grant Information

Under which category of service does your program/project fall under?*

Promotion of educationCivic improvement and promotion of public welfareBeautification of our communitySupport area youth activities

Share with us the summary of your program/project:*

Share with us your annual program budget and/or the project budget: *

List any other sources of funding for this program/project:

Who will benefit from the efforts of this program/project?*

Are there any other organizations or individuals that are willing to match any funding awarded?*

If yes, please explain.

How will the funds be used? *

Why is this program/project needed and what is the anticipated outcome? *

What is your project timeline? *

Has your organization ever been awarded a Payette Lakes Progressive Club grant in the past?*

If yes, describe how it has impacted your program/project.

If funds are awarded, your organization will be required to provide documentation or other means to demonstrate use of funds were in good faith with this application. Please acknowledge or decline.*

If funds are awarded, might it be possible to credit Progressive Club support?*

Total Funds Requested:*

Is your organization registered as a 501(C)3?

If so, please provide the EIN:

Please share any thoughts, comments, or additional information that you want to add to this application:

Please type in your name to serve as a digital signature:*