___________________________________________________________________________________________________________________________
TOWN OF CUTLER BAY
CUTLER BAY COMMUNITY FUND GRANT PROGRAM
MINI-GRANT APPLICATION
Organization Name: ____________________________________________________________________________________
Mailing Address: ____________________________________________________________________________________
City/State/Zip Code: ____________________________________________________________________________________
Phone#: __________________________________________ Fax #: _________________________________
E-mail Address: ____________________________________________________________________________________
Website Address: ____________________________________________________________________________________
Name of Contact Person: _____________________________ Title: ______________________________________________
ORGANIZATION INFORMATION
Is the organization incorporated? Yes No FEIN#: __________________________
Does the organization have 501(c)(3) Tax Exemption Status? Yes No
Does the organization have a Board of Directors? Yes No
If yes, provide a list of your current board members with your application.
Total # of Board Members: ________ # of Staff: _________ # of Volunteers: __________
Does your organization carry Liability Insurance? Yes No Amount:_______________
PROPOSAL INFORMATION
Program/Project Name: _____________________________________________________________________________________________
List Specific Town Priority Area that will be addressed if funded:_________________________________________________
Target Age Group: ____________ # of Residents To Be Served: __________
Amount of Request $: _______________ Total Program/Project Cost:_____________
Source(s) of Additional Funding:_____________________________________________________________________________
Has your organization received previous funding from the Town: Yes No .
If yes, please List Amount:
Funded $:______________________ Year:________________ # of Residents Served:_________________________
Please provide a brief summary of the Previous Project Funded: _________________________________________________
Authorized Signature of Board Chair/Executive Director:__________________________________________________________
Date: ________/_______/_______
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