Starved Rock Cycling Association

Community Project Application

TO COMPLETE APPLICATION PRINT FORM

PLEASE PRINT NEATLY OR TYPE

Name of Individual or Organization:____________________________________________________________

Address:_____________________________________________________________________

City, State and Zip:_____________________________________________________________

Contact Person:____________________________________Title:________________________

Contact Phone Number:_____________________________

E-Mail address:____________________________________

Web Page (if applicable)_____________________________

Organization Tax ID Number and/or tax status:_______________________________________

 Total cost of the project, event, or program must be in our scope of Mission Funding Guidelines (See Form A) "Specifically Bicycle Related Programs in the Community"

 Amount requested:________________________ Date when funds needed:_________________

Include with this application page and attach the following information PRINTED OR TYPED,

1. A brief description of the organization's or entity's purpose, goals, and mission.

2. A description of the program, project or event for which funding is requested including its purpose or mission to be achieved (bicycle related), impact for promoting bicycling in the community and how the impact will be measured success of the project, program or event.

3. A budget for the project, program or event relating to Starved Rock Cycling Association Mission and Funding Guidelines, with funding sources, and expenditures.

4. Date that funding will be needed.

5. Is this program, project or event a one time community endeavor?

6. Have you or your organization received funds from Starved Rock Cycling Association in the past? If so, describe.

7. Attach any relevant brochures, media, financial budget/statement, newsletters, media related articles that describe or support the program, project or event.

NOTE: Application page and all supporting documentation may be submitted in hard copy to SRCA, PO Box 2304, Ottawa, IL 61350 or electronically to starvedrockcycling@yahoo.com.
11-21-10