Grant Application

Recipient Information

Name of Organization or Individual

Email Address

Contact Person (if different)

Phone

Address

Tax Status

Tax ID #

Purpose

If the request is for an event, list the date and name of the event.

How many Teller County Children will benefit directly from your efforts?

How exactly will the funds you are applying for be used? Describe the event, or list local projects/economic benefits. Please be specific.

Event Name

Number of Children

Date

Amount

Total amount required for your event/funding request?

Amount you are requesting from Ute Pass Woodland Park Kiwanis.

Total Dollar Amount

Amount Requested from Kiwanis

Other Donations

Have you approached other organizations for support?



How much was given by other sponsors?

List your major contributors:

Have you planned any additional fundraisers? Please list:

Are any Ute Pass Woodland Park Kiwanis Volunteers actively involved?

If Yes, please list their names and how they are involved:

Yes

Amount from Other Sponsors

List Other Sponsors

Other Fundraisers

Yes

Names

Additional Information

What is the primary focus of your organization, program or project? If other local organizations provide the
same or similar services, please indicate how your program is unique

How will this Event or Project benefit local Teller County Children?

Would you or members of your organization volunteer at a Kiwanis-sponsored event such as Kiwanis Bingo?

Yes

How will Ute Pass Woodland Park Kiwanis be recognized for investing in your project, event or organization?

I certify that the information above is correct and that the contribution, if approved, would be used solely
as described above.

Your Signature

Date

Thanks for submitting!