Form Center

2. Town of Frederick Community Grant
4. Organization Name*
6. Address1*
8. Address2
10. City*
11. State
12. Zip
14. Contact First Name*
15. Contact Last Name*
17. Contact Phone Number*
18. Contact Email Address*
20. Federal/State Tax ID*
22. Please describe your project and the reason for your request.*
24. Amount Requested*
25. Number of Frederick residents and/or visitors will participate and/or benefit from the program/project:*
27. In what way will this program enhance the Town of Frederick's positive image, provide opportunity for informal education, community building and/or family entertainment?*
29. Have you requested support from other sources? Please provide a list of organizations that you have solicited or will be soliciting:*
31. Has your organization applied for a grant from the Town of Frederick before?*

    1. Yes
    2. No
32. If you were awarding funding in the past, how much did you receive?
34. If you received funding in the past, how did you use the funds?
36. If you received funding in the past, were there funds leftover? If so, how were the funds utilized?
40. Program/Project Budget
42. Program/Project Name*
44. Total Project Budget:

    Please provide a complete project budget list including personnel, promotion, supplies, services etc. The budget can be itemized below. 

46. Item/Amount*
47. Item/Amount
49. Item/Amount
50. Item/Amount
52. Item/Amount
53. Item/Amount
55. Item/Amount
56. Item/Amount
58. Item/Amount
59. Item/Amount
61. Total Project/Program Budget:*
63. Please List Any Sources of Funding Secured*

    To include any gifts and/or grants pledged or paid. If none received please enter N/A

65. Request for Additional Funding

    If the request is for funds exceeding $500.00 please explain why your organization has requested funding beyond the $500.00 grant award.

67. Please including the following attachments for inclusion in your application.
69. Board of Directors and Key Staff noting any paid staff.*
71. IRS Determination Letter indicating Tax-Exempt Status of the Organization*
73. By signing below, I certify that all information is true and correct to the best of my knowledge.*

    Signature 

74. Date*
    Date
Leave This Blank:


76. 1. Receive an email copy of this form.
77. Email address

    This field is not part of the form submission.

78. Submit

* indicates a required field