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Fennimore Area Foundation (FAF) Organization __________________________________________________ Address ______________________________________________________ Telephone __________________________ Contact Person ________________________________________________ Project Information: Project Title ____________________________________________________ Amount Requested ______________________________________________ Duration of Project: From ___________________ To ____________________ When are funds needed? ________________________ Description of population served ___________________________________ Number of people to be served _______________ Briefly Summarize the Proposed Project: (Do not be limited by space provided) Identify the problem or need to be addressed: Identify the project goals or objectives: Identify the proposed strategy to accomplish these goals: Is this a new or ongoing activity on the part of the sponsoring organization(s)? Explain: Identify other principal sources of support: Please attach the following if applicable: - Complete list of organization's officers and directors. - The organization's actual income and expense statement for the past fiscal year, identifying the organization's principal sources of support, or the organization's 990 for the most current year. - Copy of the IRS federal tax-exempt determination letter. Mail to: Fennimore Area Foundation (FAF) P.O. Box 134 Fennimore, WI. 53809 Questions regarding this application form and FAF grants may be directed to: Joe Grimme (608) 822-3258 or Alice Mudler (608) 822-3187 |