PROJECT TITLE:______________________________________________________________
ORGANIZATION:_____________________________________________________________
CONTACT PERSON:___________________________________________________________
ADDRESS AND TELEPHONE:___________________________________________________
AMOUNT REQUESTED*:_______________________________________________________
PROJECT DATE(S) AND LOCATION(S) OF ACTIVITIES/PRESENTATIONS:
_____________________________________________________________________________
TARGET POPULATION: ________________________________________________________
PROJECT DESCRIPTION: _______________________________________________________
Include:
1) What do you plan to do. Be specific.
2) How you will know if you have accomplished your goal.
BUDGET:
SUPPLIES:
POSTAGE/TELEPHONE
TRAVEL:
PUBLICITY:
OTHER EXPENSES
TOTAL:
*Awards are limited to ___________ per application.