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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

    An application fee of $25.00 must be submitted with this application by clicking Make Payment Now. NOTE: Please make payment after submitting your application.

    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.

    Make Payment Now (Please make payment after submitting your application)

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