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GRANT REQUEST
Application Deadline (postmarked) is May 1, 2008.
Date:______________________
Organization/Agency Requesting Funding:_______________________________ ________________________________
Project:____________________________________________________________ __ Fed. Tax ID#________________
Address:___________________________________________ City:_____________________ State:____ Zip:_________
Contact Person and Title:____________________________________________________________________________
Telephone:_________________________ Fax:_________________________ E-mail:____________________________
Amount Requesting:$________________ Total Project Budget:$_________________ Agency Budget:$______________
Timeframe for Project:_________________________________ Preferred payment date:_________________________
Type of Request:
New Program/Project
General Operations
Support
Capital
Equipment/Materials
Ongoing Program Support Other: ________________________________________
I. Organization
A. Briefly describe the purpose/mission of your organization:
II. Project
A. Describe the Community Need/Problem being addressed by this project.
B. Project Description.
1. Briefly describe the project.
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2. Describe expected outcomes. (How will you know if the project has been successful? How will the success of the project be measured?)
C.Describe Targeted Audience.
III. Financial Information.
A. How will the funds you are requesting be used? (Please describe in narrative form, and attach detailed Project Budget)
B. Other Funding Requests.
Please list all other sources you are requesting funding from, the amount you are requesting and if funding has been approved. Please include general fundraising activity and in-kind services information.
C. Plans for On-Going Funding.
Application must be type-written or formatted similarly on your computer.
Comments must be limited to two pages. (Appendices are allowed.)
See “Grant Application Procedures & Checklist” brochure for further submission requirements.
Incomplete applications cannot be considered.
www.cfneia.org/bremerApplication deadline (postmarked) is May 1, 2008.