Mini-Grant Application

Mini-Grant Application

Due October 31
Mini-Grant Application for Fiscal Year 2024-2025
Contact Information where Mini-Grant check should be mailed:
Date of Application*

MonthDayYear
Chapter Name*
c/o (name associated with mailing address)

First NameLast Name
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Phone Number*
Contact Email*
A confirmation email will be sent to this address
Mini-Grant Amount Requested*
Maximum request $400
Check should be paid to the order of ?*

ChapterOther
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The signatures of TWO Chapter Representatives will be be required because you have specified that the check be paid to a non-Chapter alternative.

(Additional instructions will be provided at the end of the form)

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Proposed Project(s) Summary
How does your Chapter propose to use the funds?*
What group(s) will benefit from your Community Service with these funds?*
(List organizations you plan to support)
How will your Chapter members support the project?*
(Labor, donated materials, financial support ... )

Signature for Chapter Check

One signature from Chapter Leadership is required
By electronically signing this application, the Chapter agrees to use the funds (if granted):
- only as indicated on this application,
- to expend the funds in the current fiscal year,
- and to submit a report on the use of the funds no later than August 31, 2025.
Note that receipts for purchases (originals or copies) are required as part of the report; if reciepts are not available, then you must provide a DETAILED description of all purchases.
Name of Chapter Representative*

First NameLast Name
Position of Chapter Representative*

Chapter ChairChapter TreasurerOther
Email of Chapter Representative*
For confirmation purposes
Signature of Chapter Representative*

Clear
What happens next ...
1. Please print a copy of this Mini-Grant Application for your records (right button below) before you submit (left button below).
2. Click the SUBMIT button. You should receive an automatic email confirmation very soon after you submit the report.
3. The AQG Secretary and/or another Board member will follow up with you if there are any questions or issues.
Thank you and your Chapter for participating in the AQG Mini-Grant program!

Signature for Non-Chapter Check

Two signatures from Chapter Leadership are required.
By electronically signing this application, the Chapter agrees to use the funds (if granted):
- only as indicated on this application,
- to expend the funds in the current fiscal year,
- and to submit a report on the use of the funds no later than August 31, 2025.
Note that receipts for purchases (originals or copies) are required as part of the report; if reciepts are not available, then you must provide a DETAILED description of all purchases.
Name of Chapter Representative #1*

First NameLast Name
Position of Chapter Representative #1*

Chapter ChairChapter TreasurerOther
Email of Chapter Representative #1*
example@example.com
Signature of Chapter Representative #1*

Clear
Sign in the box with your mouse or finger
Name of Chapter Representative #2*

First NameLast Name
Position of Chapter Representative #2*

Chapter ChairChapter TreasurerOther
Email of Chapter Representative #2*
example@example.com
Signature of Chapter Representative #2

Clear
DO NOT Sign now - See instructions below
The signature of a second Chapter Representative is requried in order to COMPLETE this Mini-Grant Application.
1. You may print a copy of this application for your records (right button below) before you SUBMIT (left button below).
2. A PDF copy of this Incomplete Application will be sent to BOTH Chapter Representative email accounts listed on this form.
3. The Second Representative must PRINT, SIGN, and MAIL a copy of the Application to the AQG Secretary before the October 31 deadline in order for the application to be considered complete.
If you have any questions, please contact treasurer@aqgmail.org
Initial here to confirm that you understand the remaining steps required to complete this Mini-Grant Application: (initials)*
Should be Empty:

Mini-Grant Application

Mini-Grant Application for Fiscal Year 2024-2025

Proposed Project(s) Summary

Signature for Chapter Check

Signature for Non-Chapter Check