Grant Application

To be considered for funding, please complete all portions of this form, adhere to the stated maximum
sizes and submit only typed material.

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CONTACT INFORMATION

Legal Name of Organization

Federal Tax I.D. #:

Date Submitted ×

Address

City

State

Zip Code

Website

Phone

Executive Director Name

Contact Name (if different from above)

Contact Title

Contact Email

Contact Phone

Ext.

Fiscal Agent Name (if applicable)

ORGANIZATION INFORMATION

Brief Overview of Organization (History, key activities and programs) – 1,100 characters maximum

# Full-time Employees

# Part-time

# Volunteers

Organization Budget (most recent completed Fiscal Year)

Revenue: $

Expenses: $

Sources of revenue from most recent completed Fiscal Year (List % of total revenue.)

	%
	%
Corporations	%
Fees (program or other)	%
Foundations	%
Government	%
Individuals	%
Other( please list):	%

PROJECT INFORMATION

Description of Project for which you are seeking support - 1500 characters maximum

How will Les Paul’s Story be included in this project? 500 characters maximum

Project Budget

	Funding Sources	Anticipated Amount	Committed Amount
	Funding Sources	Anticipated Amount	Committed Amount
Organization #1	Funding Sources	Anticipated Amount	Committed Amount
Organization #2	Funding Sources	Anticipated Amount	Committed Amount
Organization #3	Funding Sources	Anticipated Amount	Committed Amount
Organization #4	Funding Sources	Anticipated Amount	Committed Amount
Organization #5	Funding Sources	Anticipated Amount	Committed Amount

Total Income

Total Expenses

Project Timeline - 750 characters maximum

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