NORTHWEST MINNESOTA FOUNDATION

GRANT PRE-PROPOSAL FOR FUNDING

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ORGANIZATION INFORMATION

Applicant organization_____________________________________________________________________________________________

Address_________________________________________________________________________________________________________

City___________________________________________________ State ___________________ Zip_________________________

Contact person/title_______________________________________________________________________________________________

Telephone #________________________ Fax #_________________________ E-mail address__________________________________

IRS tax exempt status (check one) _____Public ____501(c)(3) Federal I.D. number_______________________________________

FINANCIAL INFORMATION

Total project cost $_____________________________ Amount requested from NMF_______________________________

Other funding sources to which you are applying for this project:

REQUESTED COMMITTED OR DATE OF

SOURCE AMOUNT PENDING COMMITMENT

PROJECT INFORMATION

Project title _____________________________________________________________________________________________________

Project duration (list beginning and end dates) _________________________________________________________________________

Brief summary of your request_______________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

Geographic area to be served by project _______________________________________________________________________________

Grant category (check one) _____ Community Planning Program

_____ Caring Communities Program

_____ Natural Resources Program

For NMF Office Use Only

Application #________________

Serial #_____________________

Date Received_______________

Application #_______________________

Serial #____________________________

Date Received______________________

EXECUTIVE DIRECTOR OR BOARD CHAIR

_______________________________________

Signature

_______________________________________

Date

(OVER)

PROJECT DESCRIPTION (Please limit information to this sheet. Do not submit additional materials unless requested.)

1. Please describe the opportunity, challenge, issue or need that your proposal addresses.

2. How will your project address the above situation?

3. How will you know if you succeed?

The NMF is committed to fairness, objectivity and non-discrimination in its funding policies

Revised 6/03