Kittitas County Developmental Disabilities Program
2019 Request for Kittitas County Courthouse Food and Beverage Services
Name of Applicant Organization: __________________________________________
Mailing Address: _______________________________________________________
City, State, Zip: _________________________________________________________
Phone: ________________________________________________________________
Fax: __________________________________________________________________
Email Address: _________________________________________________________
Website: ______________________________________________________________
Federal Tax Identification Number: ________________________________________
Type of Organization:
o Government
o Non-Profit
o For-Profit
o Other (please specify):
Name of Organization
Phone: _________________________________________________________
Email: _________________________________________________________
Project Contact Name: ____________________________________________________
Title: ___________________________________________________________________
Phone: _________________________________________________________________
Email Address: ___________________________________________________________
Fiscal Contact Name: _____________________________________________________
Phone: _________________________________________________________________
Email Address: ___________________________________________________________
Name and Title of Authorized Representative:
Acceptance of this application may be subject to subsequent compliance reviews, including a review
of the latest audit of financial statement. Preparation of an application does not guarantee that
applicants will receive funds. By signing this grant application form the undersigned certifies that all
information is accurate to the best of his/her knowledge.
__________________________________ ____________
Signature of Authorized Representative Date
1. Applicant Profile and Qualifications: Tell us briefly about your organization including
your mission, history, and years of experience providing food and beverage services and
supervising employees(max. 250 words)
2. Community Involvement: Describe your agency’s involvement within the local
community. Identify current and historical community services including donations,
events, or sponsorships in the community.(max. 250 words)
3. Diversity: Describe your agency’s workplace diversity. Additionally, please list any
applicable agency policies, development plans, or employee handbook information.
(max. 250 words)
4. Inclusivity: Describe your agency’s workplace inclusivity. Additionally, please list any
applicable agency policies, development plans, or employee handbook information.
(max 250 words)
5. Project Description Summary: Indicate how your proposed activities will meet the
requirements of the Professional Services Agreement. (max. 500 words)
6. Funding Utilization: Describe how the funds will be used to support the proposed
activities. For example, will the funds be used for staff time, supplies, consultants,
travel, training, direct customer services, etc.? (max. 250 words)
7. Sustainability: Describe your agency’s sustainable business practices and how your
agency will ensure services beyond initial start-up funding. (max. 250 words)
8. Additional Information: Please list any additional pertinent information for your
organization that has not been asked in the previous application questions. (max. 250