Section 1. APPLICANT INFORMATION Name of Applicant: (Attach copy of W-9) Name and of Chief Officer: Name: Title: (If more than one, attach a list of all Address: officers) Fax: E-mail: Applicant Address: City, State, ZIP Code: Telephone: Fax: E-mail: Website: Applications must be received no later than * 5 p.m. Monday, November 25, 2013 – Applications may be mailed or delivered to: * 535 W. Jefferson St., Floor Springfield, IL 62761 * Fax copies will not be accepted * Submit one signed original and three photocopies of the application. *Please also email a PDF of your application to * Section 2. APPLICANT GRANT HISTORY Description of applicant organization: (200 Character Maximum) Has this applicant received a grant from the federal YES NO government or the state of Illinois within the last three years? Agency providing grant funding: If yes, provide the following: Grant number: (Add additional rows if Grant amount: needed) Grant term: Brief description of grant:
Section 1. APPLICANT INFORMATION Name of Applicant: (Attach copy of W-9) Name and of Chief Officer: (If more than one, attach a list of all officers) Name: Title: Address: Fax: E-mail: Applicant Address: City, State, ZIP Code: Telephone: Fax: E-mail: Website: Applications must be received no later than * 5 p.m. – Monday, November 25, 2013 Applications may be mailed or delivered to: * 535 W. Jefferson St., Floor Springfield, IL 62761 * Fax copies will not be accepted * Submit one signed original and three photocopies of the application. *Please also email a PDF of your application to * Section 2. APPLICANT GRANT HISTORY Description of applicant organization: (200 Character Maximum) Has this applicant received a grant from the federal government or the state of Illinois within the last three years? If yes, provide the following: (Add additional rows if needed) YES NO Agency providing grant funding: Grant number: Grant amount: Grant term: Brief description of grant:
TFTC_Grant_APP_na_fy14_15.docx