From: Subject: Prairie Meadows Community Betterment Grant Application Date: Wed, 13 Apr 2011 16:28:34 -0500 MIME-Version: 1.0 Content-Type: text/html; charset="Windows-1252" Content-Transfer-Encoding: quoted-printable Content-Location: https://www.grantrequest.com/SID_1343/Default.asp?PRINTER=1&SESID=1b6ee102d22f4921be836823088c833e&AID=20158 X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2900.5994 Prairie Meadows Community Betterment Grant = Application

Prairie Meadows Community Betterment Grant=20 Application

    Organization=20 Information


Name of Nonprofit Organization:  

 		  
Tax=20 ID Number:  

 		  
Mailing Address:  

 

 
City:  

 		  
State:  

 		 <Select=20 One>  
Postal Code:  

 		  
Organization Phone:  

 		  
Fax=20 Number:  

 		  
Organization General E-mail Address:  

 		  
Website Address:  

 		  

    Organization Executive=20 Director

 
Prefix  

 		 <Select=20 One>  
First Name:  

 		  
Last Name:  

 		  
Phone Number:  

 		  
E-mail Address:  

 		  

    Contact Person for this = Grant=20 Application

 
Click here if same as Organization Primary = Contact  

 		  
Prefix:  

 		 <Select=20 One>  
First Name:  

 		  
Last Name:  

 		  
Title:  

 		  
Phone Number:  

 		  
E-mail Address:  

 		  

    Fiscal Agent=20 Information

 
Will your organization be using a fiscal agent if=20 awarded?  
If yes,=20 check the box below.  

 		  
Name of Fiscal Agent:  

 
 
Fiscal Agent Tax ID Number:  

 
 
Fiscal Agent Mailing Address:  
(enter=20 mailing address, city, state and zip)  

 



 

    Project=20 Overview


Project Title  

 
 
Amount of Funding Requested from Prairie = Meadows  

 		  
Total Project Budget  

 		  
Project Summary  
Provide=20 one paragraph (maximum 150 words) summarizing the project for = which you=20 are requesting funding.  

 









 
Primary Program Area  

 		  
Primary Geographical Area Served  

 		  
Population Served  

 		  
Age=20 Group Served  

 		  
Ethnicity Served  

 		  
Gender Served  

 		  

    Project Description and=20 Detail


Describe the proposed project, outlining the community = needs it=20 will meet. Include the goals of the project, who will benefit and=20 why?  

 









 
What is the timeline of the project?  

 









 
Project Start Date:  

 		  
Length of Project:  
(In=20 whole months)  

 		  
How=20 will your organization measure and evaluate the project's=20 results?  

 









 
What are your organization's plans to sustain the=20 project?  

 









 
How=20 will your organization recognize the grant award from Prairie = Meadows if=20 your application is approved?  

 









 

    Project=20 Budget


Amount Requested from Prairie Meadows:  

 		  
Total Project Budget:  

 		  
List the amount of funding your organization currently = has secured=20 for this project:  

 		  
List the amount of funding your organization currently = has pending=20 for this project:  

 		  
List the amount of the funding that will be sent to your = national=20 organization or governing entity if your organization receives the = amount=20 that you are requesting:  
If not=20 applicable, enter $0.  

 		  
Name and relationship to national organization or = governing=20 entity:  
If not=20 applicable, enter N/A  

 
 

    Organizational=20 Overview


What is the mission of your organization?  

 









 
What is your organization's area of = expertise?  

 









 
List your organization's achievements and recognition = received in=20 the past three years?  

 









 
Outline any other grant request your organization has = made or will=20 be making to Prairie Meadows in 2011. Include project titles and = request=20 amounts. If no other applications are being made, enter = N/A.  

 









 
Has=20 your organization ever been cited for unlawful conduct? If so, = please list=20 the cause, date and reason.  
If not=20 applicable, enter N/A  

 









 
Please list the names of any Prairie Meadows employees, = members of=20 the Grant Advisory Committee or the Board of Directors that are = associated=20 with your organization.  
If not=20 applicable, enter N/A  

 









 

By typing my name and title below, I acknowledge = that this=20 project has the support of the organization and board of = directors. This=20 application is a direct representation of the=20 organization.

  
     
Name:  

 
 
Title:  

 
 
Date: