Grant Request: Cycle I ______ (by Sept. 10) Cycle II ______ (by Mar. 15)
Grant Applicant: Organization/Club ________Individual ________ (check one)
Name of Organization/Club: ______________________________________
Name of Contact Person: _________________________________________
Address: ______________________________________________________
City: ____________________________________State: _____ Zip : ______
Telephone: Home: ___________________ Business: ___________________
Fax No.: ___________________ E-mail Address: _____________________

Project Information

Answer the following questions. Be complete and give details where appropriate. All answers must be included in this document. Additional information can be submitted, where indicated.

What is the title of the project?

Write a one sentence description of the project.

Describe the project and how it will address a problem.

When and where will the project take place?

How will the project measurably improve the community or region?

How will you measure the success of the project?

How will you build on the success of the project?

Who will be working on the project?
Attach names, addresses, telephone numbers on a separate page to the application.

Is there another organization that will collaborate with you on the project? If so, give the name of the organization, the name of the contact person, their position and telephone number.

Give a detailed time line of the project. (Attach a separate sheet if needed)

What parts of the project require funding? Attach a detailed budget of the proposed project. Include price quotes if possible. Also indicate any elements of the project that are being donated and by whom.

AGREEMENT WITH THE CAPITAL DISTRICT KIWANIS FOUNDATION

By signing this proposal you agree to:
Submit a final written report within 45 days of the completion of the project.
Use all grant monies for the purposes detailed in the application
Keep accurate financial records and include them in the final report
Allow the project to be used in any media or future promotional campaign

Submit application to:

Charles P. Adams
Executive Secretary
Capital District Kiwanis Foundation
1601 Charrington Drive, Midlothian, VA 23113