Individual/Organization Name * Primary Contact Phone Number * (###) ### #### Primary Email * Mailing Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Preferred Form of Contact * Phone Email Brief describe of goals/mission * Project Description * Describe your project goals and how GRG funds could help achieve those goals. How much money are you requesting? * Have you requested funding for this project before? * Yes No If you selected Yes, with who/what organization? If you selected Yes, when? MM DD YYYY If you selected Yes, how much if any was awarded? How will the money be spent? Include revenue and expenses * Break down your budget (Sample budget here) What other community organizations are you collaborating with on this project, if any? Expected Start Date * MM DD YYYY Expected End Date * MM DD YYYY Goals * The goal of Grassroots Grants is to empower innovative, impact-oriented projects in Patrick County and surrounding areas to enhance the community through education, creative placemaking, arts, and culture. Which of these goals does your project address? Education Creative Placemaking Arts Culture Other For each goal you checked, describe how your project addresses them. Does your project currently utilize social media? * Yes No How do you plan to market or increase awareness of your project? * Newspaper Social Media Website Radio Flyers Other Opt in to receive emails regarding future opportunities to participate in or support GRG/OFP Opt-in By submitting this application I agree that my answers here are as truthful and as accurate as possible. Any potential conflicts of interest that may impact my eligibility for award funding have been, to the best of my knowledge, communicated to OFP. If for any reason I am unable to implement this project within the timeframe specified in this application or as agreed upon with the funder I will return my award fund to OFP. I agree to represent OFP and the Grassroots Grants brand when promoting my project. Please refer to the guidelines here for information on using OFP/GRG branding and logo. * I agree Signature/Name * Thank you for submitting your project proposal. The Grassroots Grants team will review your submission and be in touch with questions or next steps. If you have specific questions please contact us at grassrootsgrants@onefamilyproductions.com
