Wild Rivers - GRANTS APPLICATION

GRANTS APPLICATION

Amount Requested:		Email Address:
Program Title:		Name of Organization:
Address:		City:
State:		Zip:
Phone:		Fax:
Executive Officer:		Title:
Contact Person (if different from above)		Title:
Does organization have tax exemption? Yes No		Tax ID #:
Name of agency/organization holding tax-exemption: (If other than the applicant)
Please supply all of the information requested below in the space provided (please be brief). Feel free to attach any information you have that will help us understand your program (flyer, application, etc.). Allowed extensions: gif,jpg,doc,txt,eps,exe,cvs,html,xml Maximum Filesize: 524288 bytes
1. Description of Summer Program and how it fulfills a recreational and/or youth developmental need:
2. Projected dates, hours and location of Summer Program:
3. Cost to participant and criteria for participation:
4. If your organization ran a Summer Program in 2006, list the: a. Total number of Del Norte County or Curry County children served during 2006 Summer Program: b. Counting each child only once; average number served daily last summer: Ages 0-5 Ages 6-10 Ages 10-14 Ages 15-18 Total c. Number of scholarships provided for families who could not afford the fee: and criteria for receiving a scholarship (attach your guidelines if applicable): Allowed extensions: gif,jpg,doc,txt,eps,exe,cvs,html,xml Maximum Filesize: 524288 bytes
5. Total number of Del Norte County or Curry County children anticipated in 2007 Summer Program:
6. If you received funding from the Wild Rivers Community Foundation for your Summer Program last year, give a brief accounting of the expenditure of those grant funds:
7. Do you have or will you seek funding for this program or for scholarships from other sources? If so, from whom and how much?
8. Budget for this summer recreation program (please be specific):
9. Detailed list of specific items requested and cost:

= Required