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| 1. Name, address and phone number of organization applying for this grant: | _________________________________________________________
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| 2. Name, address and phone number of person in charge or managing the project: | _________________________________________________________
_________________________________________________________ _________________________________________________________ _________________________________________________________ |
| 3. List the officers of the organization: | _________________________________________________________
_________________________________________________________ _________________________________________________________ _________________________________________________________ |
| 4. Describe the exact location of this project: | _________________________________________________________
_________________________________________________________ _________________________________________________________ |
| 5. Describe in detail the project and how it would benefit your community:
(Use additional Sheet if Required) |
_________________________________________________________
_________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ |
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| 6. Attach a detailed budget. Show value of other donations of cash, labor, or materials which will be used to complete your project.. | |
| 7. List additional sources of funds if not on budget: | _________________________________________________________
_________________________________________________________ _________________________________________________________ |
| 8. When is this project scheduled to begin?
to be finished? |
_________________________________________________________ _________________________________________________________ |
| 9. If your organization is not awarded this grant, will the project continue? | _________________________________________________________
_________________________________________________________ _________________________________________________________ |
| 10. Attach a letter of support from one of the following: Mayor or City Manager, School Board or School Superintendent, Local Service Club President, Chamber of Commerce Manager or Board of Directors. | |
| 11. Drawings, sketches or newspaper articles may also be attached. | |
| 12. Deadline for application is March 31, 2005. | |
| Date _____________________ Signature ________________________________________ | |
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