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City of Douglas Economic Development Funding Application Page 1 of 4 1. ATTACHMENTS A comprehensive project budget is required for grant request(s). You may use Section 10 below to complete your detailed project budget information, or you may attach a separate sheet. 2. PROJECT GRANT PROPOSAL – FORM #1 CHECKLIST Proposal overview Proposal narrative Project budget 3. PROPOSAL INFORMATION Date of application: 4. ORGANIZATION INFORMATION Organization Name: Primary Contact Name: Primary Contact Email: Primary Contact Phone: EIN# IRS Status: 5. PROJECT PROPOSAL SUMMARY Brief Project Description (also attach full project description per Section Anticipated Start Date: Estimated Completion Date: Population served: Geographic area served (e.g. Douglas, Converse County, other): Desired impact: Promotional activities (e.g. Facebook campaign, advertising, members only, etc.): ---PAGE BREAK--- City of Douglas Economic Development Funding Application Page 2 of 4 6. PROJECT BUDGET SUMMARY Total project budget for Fiscal Year: $ Total project budget: $ Dollar amount requested: $ Total matching: $ Total In-kind: $ Other: $ Percent of amount requested of total project budget: 7. LIST TOP FIVE MAJOR FINANCIAL CONTRIBUTORS TO PROJECT Additional Contributors Cash Amount In-kind Amount C, R or P* $ $ $ $ $ $ $ $ $ $ *Indicate a for committed sources of funding, for requested, but not committed sources of funding, and for potential sources of funding. 8. PROJECT PROPOSAL NARRATIVE AND INFORMATION Please use the following outline as a guide to your project proposal narrative. Please respond to each question in the order listed, providing your responses in a separate document. It is not necessary to include the original questions; however, please provide the letter of each question and a space between each response. Please limit your narrative response to no more than three pages. If a question does not apply to your organization, please put n/a. A. Provide a brief summary of the opportunity, challenges, issues or needs associated with your project. B. Provide an overview of the project and denote how it meets community and/or City of Douglas goals. C. Describe the time frame in which the project will take place, including completion date. D. Describe whether the project is a new or ongoing program for your organization. E. Describe your overall goal(s), desired impacts/outcomes for your project, and objectives or ways in which you will meet the goal(s). F. Describe your criteria for success. Be as clear as you can about the impact you expect to have. What do you want to happen as a result of your activities and how will you measure the project’s success? You may find it helpful to describe both immediate and long-term effects. G. Who will be involved in evaluating this work? ---PAGE BREAK--- City of Douglas Economic Development Funding Application Page 3 of 4 H. Who will be involved in completing and maintaining this project, including any associated contractors or other contract labor? I. Are you seeking or have you received any other funding for this project? 9. OPTIONAL PROJECT BUDGET This format is optional and can serve as a guide to budgeting. If you already prepare project budgets that contain this information, please feel free to submit them in their original forms. Feel free to attach a budget narrative explaining your numbers if necessary. INCOME Source Amount Revenue/Earned Income 1. $ 2. $ 3. $ 4. Other (specify) $ 5. Other (specify) $ Support/Contributed Income 6. $ 7. $ 8. $ 9. $ 10. Other (specify) $ Total Income $ EXPENSES Item Amount 11. Salaries and wages $ 12. Insurance, benefits and related taxes $ 13. Consultants and professional fees $ 14. Travel $ 15. Equipment $ 16. Supplies $ 17. Printing and copying $ 18. Telephone and fax $ 19. Postage and delivery $ 20. Rent and utilities $ 21. In-kind expenses $ 22. Depreciation $ 23. Marketing promotion $ 24. Other (specify) $ Total Expense $ Difference (Income less Expense) $ ---PAGE BREAK--- City of Douglas Economic Development Funding Application Page 4 of 4 10. ADDITIONAL INFORMATION OR COMMENTS Please include any additional information here that you feel is pertinent to this project and/or your request for funding that has not already been stated. 11. SIGNATURE By: Print Name: Title: Date: FOR OFFICE USE ONLY Date Received: Date of Council Meeting: Date of Council Approval: Amount Requested: Amount Approved: Comments: