Northlands Member Grant Application

Member Grant Application

Name of Event or Project

Date(s) of Event or Project

Requested Grant Amount ($750 limit)

Has Northlands funded the project before?

Name of Organization

Briefy describe the purpose of your organization or project

URL of website (if applicable)

Mission Statement of Organization (if applicable)

State event or project goals and how the grant will help achieve them

Include target audience, specific activities and plan of action

Estimated Total Inkind Donations

Estimated Total Cash Income

Grant Funds Requested for Artist Fees

Grant Funds Requested for Space Rental

Grant Funds Requested for Equipment Rental

Grant Funds Requested for Postage & Printing

Grant Funds Requested for Supplies

Grant Funds Requested for Miscellaneous Use

Describe Miscellaneous Use

Phone

Address

Once the form goes blank, it has been submitted to Northlands.

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