Fill out this form and
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here to print this page and return it with the appropriate
forms to: Alexandria Area Community Foundation, PO Box 488, Alexandria
MN, 56308
Legal Name of Applicant:
Address:
Name and Title of Chief Operating Officer:
Phone Number:
Names of Members of Governing Board:
Number of Full-Time Staff :
Number of Part-Time Staff:
If you are affiliated with
or accredited by any national organization, please specify:
Description, History and
Background of Applicant:
Explain need for project
and past or present attempts to meet the need:
Goals and Objectives
of the Project:
Estimated Number of Residents
in the Alexandria Area Who Will Benefit From the Project:
Specific Activities or Methods
Identified to Reach the Goals of the Project:
Names and Qualifications
of People Involved in the Project:
Time Table for Completion
of Project:
Itemized Project Budget,
Including all Anticipated Project Expenditures:
List all Sources or Anticipated
Sources of Funds for the Project:
If Project is to be Ongoing,
State How It Will Be Financed After Grant Funds Are Expended:
Amount of Request from Alexandria Area Community Foundation:
Is This For a Tax Exempt Organization? * If
Yes, See Below
Date:
By submitting this form,
I hereby certify all of the above information to be true.
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