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?

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: