Fillable COVER-PRO APPLICATION GRANT COORDINATOR / WRITER SUPPLEMENT oss (Philadelphia Insurance Companies)

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COVER-PRO APPLICATION GRANT COORDINATOR / WRITER SUPPLEMENT oss (Philadelphia Insurance Companies)

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COVER-PRO
SM
APPLICATION
GRANT COORDINATOR / WRITER SUPPLEMENT
1. Full name of the Applicant Firm:
2. What percentage of the Applica
nt’s gr
oss annual revenue comes from the following activities?
% Grant Writing
% Consulting
% Coordinating
% Research
% Managing grant funds
% Other: (specify)
% Other: (specify)
100
% TOTAL MUS
T EQUAL 100%
3. Is the Applicant certified by AGWA? Yes No
4. How is the Applicant compensated? (e.g. hourly, flat fee, percen
t
age of grant
funds receive
d)
5. Does the Applicant perform any work for college or universities? Yes No
ADDITIONAL INFORMATION
This section may be used to provide additional information to
any question on this ap
plication. Please
identify the question number to which you are referring.
I understand that the information submitted herein becomes a part of my Philadelphia Insurance
Companie
s Cover-Pro
sm
application and is subject to the same conditions as stated on the application.
Name (Please Print) Title (Must be Principal, Partner or O
fficer)
__________________________________________
Signature Date
PI-PLSP-GCSUPP 08/
10 Page 1 of 1
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COVER-PRO APPLICATION GRANT COORDINATOR WRITER SUPPLEMENT oss (Philadelphia Insurance Companies)

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Completed 7 November 2020

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