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* Contact Information

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* Describe your community program:

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* Explain how your program will benefit the community.

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* How many people participate in your program?

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* Does your program take place within Wynyard? Does your program serve predominantly Wynyard and area residents? Please explain:

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* In what ways do you plan to publicly acknowledge Saskatchewan Lotteries as a source of funds for this program (ex. posters, newspaper, radio, social media, etc.)?

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* 30% of funds coming from Saskatchewan Lotteries must go to programs that aim to increase participation by under-represented populations. Is your program aimed at increasing participation in any under-represented populations within your community? (ex. seniors, indigenous people, economically disadvantaged, women, persons with disability, youth at risk, single parent families). Please explain:

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* Budget - please list expected expenses (list each expense item and corresponding dollar amount):

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* Budget - please list expected revenues (list each revenue item and corresponding dollar amount):

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* Grant amount requested:

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