Funding Period Requested: / / through / / $ (be Amount Requested: specific) Total Project Budget for this $ $ Current Annual period: (not required if general Organizational Budget: operating request) / / through / / Organization Fiscal Year: Geographic Area(s) Served: (include specific counties) (For this project. If general operations support, for this organization.) membership List applicant’s of a giving federation: (e.g., United Way, Arts & Education Council, Jewish Federation, Earthshare Missouri) Agreement I certify to the best of my knowledge, that all information included in this proposal is correct. The tax exempt status of this organization is still in effect. If a grant is awarded to this organization, then the proceeds of that grant will not be distributed or used to benefit any organization or individual supporting or engaged in unlawful activities. In compliance with the USA Patriot Act and other counterterrorism laws, I certify that all funds received from this funder will be used in compliance with all applicable anti-terrorist financing and asset control laws, statutes, and executive orders. Signature, Executive Director Date (or authorizing official on behalf of the organization) NARRATIVE SECTION A: ORGANIZATIONAL INFORMATION 1. Summary of organization’s history. 2. Description of the organization’s current programs, activities, number served annually, and accomplishments.
Funding Period Requested: (be specific) / / through / / Amount Requested: $ Total Project Budget for this period: (not required if general operating request) $ Current Annual Organizational Budget: $ Organization Fiscal Year: / / through / / Geographic Area(s) Served: (include specific counties) (For this project. If general operations support, for this organization.) List applicant’s membership of a giving federation: (e.g., United Way, Arts & Education Council, Jewish Federation, Earthshare Missouri) Agreement I certify to the best of my knowledge, that all information included in this proposal is correct. The tax exempt status of this organization is still in effect. If a grant is awarded to this organization, then the proceeds of that grant will not be distributed or used to benefit any organization or individual supporting or engaged in unlawful activities. In compliance with the USA Patriot Act and other counterterrorism laws, I certify that all funds received from this funder will be used in compliance with all applicable anti-terrorist financing and asset control laws, statutes, and executive orders. Signature, Executive Director (or authorizing official on behalf of the organization) Date NARRATIVE SECTION A: ORGANIZATIONAL INFORMATION 1. Summary of organization’s history. 2. Description of the organization’s current programs, activities, number served annually, and accomplishments.
EPHT-CGA-20162.docx