PROJECT LEADER EXECUTIVE OFFICER OF ORGANIZATION

Name Name
Address Address

Telephone No. Telephone No.

Signature Signature

PROJECT CATEGORY (check all that apply)

¨ Project involves youth
¨ Project involves improvement to the environment
¨ Project activities are within or benefit the critical area (within 1,000 ft. of tidal waters)

PROJECT FUNDING AMOUNT REQUESTED (If granted, who should check be made payable to?)

$ ___________
PROJECT DESCRIPTION (be brief and to the point - list goals and objectives)

PROJECT LOCATION (where will the activity take place?)

PROJECT SCHEDULE (when will the activity start and when will it be completed?)

PROJECT BUDGET (include line item budget, quantity, price per item and totals, and when items will be purchased.)

DESCRIBE PLANS TO EVALUATE PROJECT SUCCESS (How will you confirm completion of the project goals and objectives to the Trust?)

HAS YOUR ORGANIZATION REQUESTED GRANTS FROM THIS TRUST IN THE PAST? (If yes, specify grant number, amount, and date.)

HAS YOUR ORGANIZATION RECEIVED GRANTS FROM OTHER ORGANIZATIONS IN THE PAST? (If yes, specify source, amount, date, and type of activity funded.)

FOR OFFICIAL USE ONLY

APPROVED__________ DATE_______________

REJECTED