Printable Grant Application

APBA Historical Society, Inc
17640 East Nine Mile Road Eastpointe, Michigan 48021
For Info Email: Info@APBAHistoricalSociety.org

NOTICE TO APPLICANT:
Fill out completely and submit ten (10) copies to the above address.
Grant requests must be received on or before December 15th.

If approved, grants are typically awarded in February of the following year.

Grant Application Form
	Name of Organization: ___________________________________________________
	Contact: ________________________		Title: __________________
	Address: ________________________	City: _____________	State :_____
	Project Location: _________________	Email: __________________________________
	Telephone: (___)_____-________	Fax: (___)_____-________
	Title of Project:
	Project Description:
	Amount of Grant Requested: Total Grant Requested $ ____________________
	.....................................................................................................................................................
	For Official Use Only:
	Grant Approved: _________________	Date: __________	Check #: ____________
	Grant Request Number: ____________	Date Received: _________________________


	1.)		Organization:
	2.)		Issues / Needs:
	3.)		Purpose:
	4.)		Who Will Be Served:
	5.)		Personnel:
	6.)		Coordination:
	7.)		Management:
	8.)		Evaluation:
	9.)		Other:
	10.)		Funding Plans:
	11.)		Project Budget:
	12.)		Certification: To the best of my knowledge and believe, statements in this grant application are true and correct; the document has been duly authorized by the governing body of the application; and the applicant organization will comply with applicable laws, regulations, terms, and conditions in effect at the time of the grant. I understand that the APBA Historical Society, Inc., in evaluating this grant application, may, if it deems appropriate, review any and all of the information submitted as part of this request with advisors of the APBA Historical Society, Inc.'s choosing. Signature: ______________________________________ Date: ___________________ < Back