Grant Application Form Please fill in all the fields. 1. Contact Information Full Legal Organization Name Street Address City Province ---AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland andLabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Organization Website Registered Charities Number Contact Contact Person Title Phone Number E-Mail Address Alternate Contact Alternate Contact Email Project Title 2. Project Information Project Description Project Impacts Project Timelines 3. Project Funding Funding Requested from Our Lady of the Prairies Foundation ($) Applicants Funding For Project ($) Funding from Other Sources ($) List of Funding from Other Sources (R = Requested, A = Approved) TOTAL Project Funding ($) Project Costs (List item/activity and cost associated) I CERTIFY that all the information provided in this and any attached documents is true and correct. I ACKNOWLEDGE that meeting the eligibility criteria does not confer a right to financial assistance. I agree with the above statement. Name and Title of Approved Signee Please be sure to include the following additional items with your application: Audited Financial Statements Budget for the Current Year Latest Annual Report Board of Directors List Your Mission Statement Recognition planned for Our Lady of the Prairies Foundation Please note that the individual attachment size is restricted to 5 MB; and the total application attachment size not to exceed 30MB.
