Mini Grant Application - City of Ranson, WV

Date *

Organization Information

Legal name of applicant organization: *

Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Physical address, if different:

Address Line 1

Address Line 2

City

State

Zip Code

Executive Director, President, or CEO name and tiltle: *

Phone *

Fax

Email *

Contact title: *

Phone *

Website / URL

Year organization was founded: *

Organization's tax exempt # (EIN): *

Organization's total operating budget for current fiscal year: *

Amount of request: *

Grant Request Information

Fiscal agent: *

Name of project: *

Project abstract: *

Please give a brief summary of project – if your grant is selected, this will be for public relations purposes.

Beginning and ending dates of project/activity: *

Total Grant Request

Total cost of proposed project: *

Amount requested in this application: *

This request as % of total project cost: *

List any previous funding received from the City of Ranson (e.g. – year, purpose & amount):

This organization is (will be) requesting funds for (Please check all that apply): *

Cost of Acquisition:

Cost of Basic Needs:

Cost of Capital:

Cost of Construction:

Cost of Crisis Intervention:

Cost of Equipment:

Cost for Families:

Cost of Fixed Assets:

Cost for Health:

Cost of Ongoing Costs:

Cost of Project/Program Support:

Cost of Renovation:

Cost of Rent:

Cost of Safety, Education & Training:

Start-Up Costs:

Cost of Supplies:

Cost of Utilities:

Other Cost:

Total: *

Date *