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DIRECTOR AND CONTACT INFORMATION

Project Director (person who is fiscally responsible for this project) *

Affiliation*

Address*

City*

State*

Zip/Postal*

Country*

Day Phone*

Evening Phone*

Fax Number*

Email*

PROJECT INFORMATION

Project Title*

Estimated Total Budget

Estimated Project Duration (beginning month and year to ending month and year)

Date of this Application

Project Description (50 words or less)

NAMES OF COMMITTED PROJECT FUNDERS

List one funder per box.

Name of First Committed Funder

Funder Type
CorporateNon-ProfitEducationalIndividualOther

Name of Second Committed Funder

Funder Type
CorporateNon-ProfitEducationalIndividualOther

Name of Third Committed Funder

Funder Type
CorporateNon-ProfitEducationalIndividualOther

Name of Fourth Committed Funder

Funder Type
CorporateNon-ProfitEducationalIndividualOther

NAMES OF PENDING FUNDING SOURCES

List one funder per box.

Pending Funding Source

Funder Type
CorporateNon-ProfitEducationalIndividualOther

Pending Funding Source

Funder Type
CorporateNon-ProfitEducationalIndividualOther

Pending Funding Source

Funder Type
CorporateNon-ProfitEducationalIndividualOther

ITEMS TO SUBMIT WITH THIS APPLICATION:

• Itemized project budget

ITEMS TO SUBMIT WITH THIS APPLICATION, IF AVAILABLE:

• A sample of work representative of the project

APPLICATION PAYMENT

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Upon approval of the application, an additional $500 pledge will be invoiced and used to open the client's restricted fund account. The donation is tax-deductible. Kindly make all payments online by clicking the link below or using the Purple Donate Button.

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