THE AMHERST CLUB LOVE NOTES 2012 GRANT APPLICATION FORM (for a Word or PDF copy of this form, contact peter_snedecor@nmhschool.org) Name of Organization and Year Founded:
Description, Mission, Locale Served:
Major Contacts--Include Name, Title, Phone, E-Mail:
Contact person regarding this application:
Description of Population Served:
FY 2010 FY 2011 Total Number of Clients Served: _______ _______
Number of Amherst Clients Served: _______ _______
Approximate Number of Volunteers Serving: _______ _______
How are volunteers used?
AMOUNT REQUESTED: ___________________ FY 2010 FY 2011
Total Cost of Program for which Funds Are Requested: _______ _______
Percentage of Requested Amount to be used for Direct Service: _______ _______
Major expense or income changes in last two years, if any:
Major Sources of Funds during the Past Year:
DESCRIPTION OF PROPOSED PROJECT: (Use a separate sheet.) |
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