Community Grants Application

Applicant Information:

Name of Organization/Group:

Organization/Group Description:

Contact Person

Co-Applicant

Street Address (Line 1)

Street Address (Line 2)

Town & Postal Code

Email Address

Telephone Number

PROJECT DESCRIPTION:

Project Name

Start Date

End Date

Project Summary

Target Group: Who is the project intended for?

Participants: How many might take part?

Goals: What do you plan to do?

Activities: How will you do it?

Project partners:

What are these partners doing to help with this project?

How will this project benefit your community?

What else would you like us to know about this project?

Project
Budget:

See Budget Example
(Below this form)

Estimated Costs
In Current Application

Estimated Costs
From Another Source

How will you recognize the contributions of the coalition? (Posters, Newsletters, etc.)

AUTHORIZATION
Do we have your permission to share information?

Do we have your permission to use any photos sent in?

I agree that the Northern Wellness Coalition has full use of information and/or photos of my event to promote healthy living in any future publication.

Successful applicants must allow approximately 6 weeks for review of application and the receiving of funds.

Community Grants Application

Applicant Information:

View Budget Example

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