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 include a copy of your most recent Audited Financial Statements as part of your application. Please note that the attachment size is restricted to 5 MB.