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Name of Organization:
Registry of Joint Stock Number ID:
Contact Person:
Position in Organization:
Home Telephone Number:
Work Telephone Number:
Email Address:
Civic Mailing Address:
General Description of Programs to be Offered This Year:
Will any new programs be started or current programs enhanced as a result of this grant?
YesNo
If yes, provide details:
Additional comments to support your application:
Registration Fees:
Facility Rentals:
Fund Raising:
Donations:
Other:
Total Revenue:
Additional Comments (e.g. for "Other"):
Part Time Staff:
Program Equipment & Material:
Program Insurance:
Total Expenses:
Amount Requested from the Municipality:
On behalf of the organization listed above, I/we hereby declare that all the information presented and/or provided with this application is true and correct.
