Small Grant Program Application Form Project Data Ref Applicant Information 1 Legal name of applicant in Czech* 2 Legal name of applicant in English* 3 Name of project in Czech* 4 Name of the project in English* Legal seat of applicant (street address, 5 city, state, country) Legal registration number of applicant 6 (ICO) or write individual 7 Website of applicant 8 Status of applicant (type of organization) 9 Year applicant was founded 10 Name of contact person 11 E-mail address of contact person 12 number of contact person Pervious US Government or US Embassy Prague Funding Information Funding 1: Include project name, amount, 13 implementation Funding 2: Include project name, amount, 14 implementation dates Funding 3: Include project name, amount, 15 implementation dates Project Information Implementation of project being 16 submitted for funding 17 Location of project implementation Target Audience and composition (age, 18 gender, occupation) 19 Total project budget Amount being requested from US 20 Embassy Prague Percentage of total budget being 21 requested from US Embassy 22 Date of Application Submission Project Context
Small Grant Program Application Form Project Data Ref Applicant Information 1 Legal name of applicant in Czech* 2 Legal name of applicant in English* 3 Name of project in Czech* 4 Name of the project in English* 5 Legal seat of applicant (street address, city, state, country) 6 Legal registration number of applicant (ICO) or write individual 7 Website of applicant 8 Status of applicant (type of organization) 9 Year applicant was founded 10 Name of contact person 11 E-mail address of contact person 12 number of contact person Pervious US Government or US Embassy Prague Funding Information 13 Funding 1: Include project name, amount, implementation 14 Funding 2: Include project name, amount, implementation dates 15 Funding 3: Include project name, amount, implementation dates Project Information 16 Implementation of project being submitted for funding 17 Location of project implementation 18 Target Audience and composition (age, gender, occupation) 19 Total project budget 20 Amount being requested from US Embassy Prague 21 Percentage of total budget being requested from US Embassy 22 Date of Application Submission Project Context