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* 1. Project Title (Limit 80 Characters)

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* 2. Friends Group Name

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* 3. Contact Information

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* 4. Check Payable

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* 5. EIN Number

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* 6. Project Timeframe

Date
Date

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* 7. List Names of County/Counties Impacted

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* 8. Grant Amount Requested ($) (The total for the grant request may not exceed $5,000)

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* 9. Total Match Amount ($)

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* 10. Total Project Cost ($)

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* 11. Grant Eligibility

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* 12. Project Approval

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* 13. Application Commitment

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* 14. Describe how your project aligns with the purpose of this grant program (250 words)

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* 15. Describe the intended impact of this project, including goals, objectives, and measurable outcomes (250 words)

BUDGET BREAKDOWN: In the sections below, enter budget information for the project.

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* 16. Budget Line 1 - List the items to be purchased and estimated cost.

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* 17. Budget Line 2 - List the match sources and amounts (For the match include cash, volunteer hour value, in-kind donations, third party support.)

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