ECARS Grant Program

* Required data

Applicant Organization Information:

Date of Application
Organization Name *
Mailing Address:
     Street Address *
     City *
     State *
     Zip Code *
Telephone (with area code)*    (use format of (999) 999-9999)
Primary email address *
Alternate email address

Website URL

Project Information:

Project Name *

Project Summary *

Project Impact *

Project Measures *
(metrics and statistics to be employed to demonstrate the impact of the project)

Key Personnel: (Include call signs if applicable)

Organization President *
Organization Treasurer *

Project Leader *

Proposal Prepared by *

Preparer email *
Preparer telephone (with area code) *

Financial Data:

Total Project Budget (including requested grant) *
Total Grant Request Amount *

(to include how the grant funds will be used. Spread sheets may be forwarded with the application.)