Application for Financial Assistance for a Business or Organization

1. Contact Information

Name of Organization:

Contact Person:

Email:

Your Address:

Your Phone Number:

Company/Organization website:

2. Type of Applicant:

Citizen GroupEducational InstitutionArts or Cultural OrganizationNon-Profit CorporationFor-Profit CorporationMuseum

3. What type of financial assistance requested?:

4. Please address the following:

Describe your need for financial assistance:

Describe any previous financial assistance that you have received from FWA or any other financial assistance you have received in the past:

If the financial need involves a project, outline the time frame for the project:

If any portion of your proposed project requires the services of an employee or a paid consultant, please explain the extent and cost of these services and why they are necessary:

Provide a detailed budget. List any in-kind contributions along with all sources and amounts of other financial assistance requested or to be requested from others:

Describe the results expected from your project, including any publications or reports:

Describe the benefits of your proposed project and how it will benefit the community: