MCR20-016 05/20
Certified Historical Institutions
Small Grant Application
Fiscal Year 2020-21
PLEASE SPECIFY
Tier 1 Grant Application ($2,000 maximum) Tier 2 Grant Application ($1,000 maximum)
Name of Organization _______________________________________________________________________________
Mailing Address ____________________________________________________________________________________
City _________________________________________________________________ ZIP Code ____________________
Physical Address of Museum _________________________________________________________________________
City ________________________________________ ZIP Code _________________ County ____________________
Phone _________________________________________ Email _____________________________________________
Project Contact Person ______________________________________________________________________________
Contact Phone _______________________________ Contact Email ________________________________________
PROJECT TITLE ____________________________________________________________________________________
CATEGORY:
Exhibitions
Public Programs
Collections Management/
Storage/Preservation
Audio/Video Recordings
Educational Materials
Grant amount requested: $_________________________
Application authorized by President’s name (type or print) ______________________________________________
President’s Signature ______________________________________________________ Date ____________________
(Digital signature accepted.)
Note: Pages 2 and 3 of this application may be completed as separate documents if additional detail is required.
SUBMIT BY JULY 31, 2020
Email completed form to: certied@azhs.gov
Or mail to: Arizona Historical Society | 1300 N. College Ave. | Tempe, AZ 85281
For questions, please call (480) 929-0292.
azhs.org