Please print or type the following: *Member/Organization Name Member Number (Internal Use Only) *Department Requesting the Grant *Name and Title of Department Head *Signature *Mailing Address, City, Zip ( ) *Email YOUR Funding Fees as described by the TFCA Best Practices and Total Amount Requested $ Recognition Program. The fee will be paid directly to the TFCA Best Practices and Recognition Program. Please describe how this funding will help your department. Please be specific. * PRINT or TYPE NAME Highest Ranking Elected Official or Chief Administrative Officer Date * SIGNATURE (Required) City Manager, CEO Title * PRINT or TYPE NAME Fire Chief Date *SIGNATURE (Required) Fire Chief * PRINT or TYPE NAME TFCA Representative Date *SIGNATURE (Required) TFCA Representative
Please print or type the following: *Member/Organization Name Member Number (Internal Use Only) *Department Requesting the Grant *Name and Title of Department Head *Signature *Mailing Address, City, Zip ( ) *Email YOUR Funding Fees as described by the TFCA Best Practices and Recognition Program. The fee will be paid directly to the TFCA Best Practices and Recognition Program. Total Amount Requested $ Please describe how this funding will help your department. Please be specific. * PRINT or TYPE NAME Highest Ranking Elected Official or Chief Administrative Officer * SIGNATURE (Required) City Manager, CEO Date * PRINT or TYPE NAME Fire Chief Title *SIGNATURE (Required) Fire Chief Date * PRINT or TYPE NAME TFCA Representative *SIGNATURE (Required) TFCA Representative Date
tfca-funding-form.docx