Preservation Howard County
Grant Application
2007

Organization Information  
Organization name:
*Contact name:
Organization address:
*Phone: *Email:
Is this organization tax exempt [501(c)(3)]?yes no
If yes, taxpayer ID:
Please briefly describe your organization's mission:
Project Information
Project location:
Amount of money requested:
Please give a detailed description of your project and how the requested funds will be used.
Include location, size, and scope:
When will the project begin?
When will the project be completed?
How will this project help your organization accomplish its mission?
Budget Information
Expenses   Please list the expected costs of the project.
Personnel:
   Administrative: $  
   Services: $  
   Other: $  
Materials (please specify and give total cost):
    $  
Other (please specify and give total cost):
    $  

Total Cost:

$

 
Income   Please list the expected funding for the project.
Grant request from PHC:  
Cash on hand:  
Individual donations:  
Corporate donations:  
Other grants:  
Other fundraising projects:  
 
Total expected income:  
Please list any in-kind or non-cash donations
(such as services or materials):
Agreement
I certify that all the information in this application is true and correct.   *
*Name:
Title:
Non-Discrimination Statement:
Title IV of the Civil Rights Act of 1964 provides that "No person in the United States shall, on the grounds of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program of activity receiving federal financial assistance" (Section 601)
I have read the above statement and our organization fully complies with its provisions.   *