Northern Chautauqua Environmental Fund
Please complete neatly.While additional attachments are allowed; brevity is encouraged!
Name of organization:
Contact person: Title:
Phone: E-mail: Fax:
Amount requested: Total project cost:
Brief description of proposed project (including goals and objectives):
What will be accomplished? By when?
What long-term impacts can be anticipated?
Project budget (total income, source of income & total expenses):
What is your total organizational budget for the year?
What are your principal sources of support?
Please tell us more about your organization (mission, current activities, geographic area served; year founded; membership; etc.):
Please attach the following:
- IRS 501 (c) 3 letter of determination
- Board list
- Staff list
- Most recent financial statement
- Budget for current year