[NOTE: If you are applying for a grant, we suggest that you download and use the RTF version of this form, which is already formatted to fit one side of one page. This HTML version is only provided so you can read the form's content online. If you use this HTML version, you will have to reformat it to fit on one side of one page.]
MUSTE INSTITUTE GRANT REQUEST ONE-PAGE SUMMARY
Organization name: ____________________________________________________________________________
Phone: _____________________________________ Fax: _____________________________________________
Email: ______________________________________ Website: _________________________________________
Contact person/title: ____________________________________________________________________________
day phone: ________________________________ evening phone: __________________________________
fax: ______________________________________ email: __________________________________________
(Note: Please use asterisks to indicate which if these is the best way to reach the contact person)
Fiscal sponsor (if any): __________________________________________________________________________
Amount requested: $___________________ (maximum grant is $2,000)
Project name: __________________________________________________________________________________
Project timeline: ________________________________________________________________________________
Project’s targeted community: ____________________________________________________________________
Type of project (check one or more): __________organizing/activism _________education ___________media
other (specify): _____________________________________________________________________________
Summary of project/request: _____________________________________________________________________
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Total project expense budget: $____________ Line item(s) for which grant is requested: ________________________
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Other funding sources for project: __________________________________________________________________
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Organization mission: ___________________________________________________________________________
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ACTUAL organizational revenue & expense totals for the fiscal year ending _____/ ______/ _______:
Revenue: $_________________ Expenses: $_____________________
Prior Muste Institute grants (specify amount, month/year and project name): _______________________________
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