Applying Organization:

Project Title

Project Director:

Financial Officer:

Organization’s Fiscal Year:

To

^Month

^Month

Beginning and Ending dates of requested funding:

To

(e.g., June 1 2000 to May 31, 2001)V

1^st Year

Project

Budget

1^st Year

Requested

2nd Year

Project

Budget

2nd Year

Requested

3^rd Year

Project

Budget

3^rd Year Requested

Total Project Budget

Total Requested

From:

From:

From:

From month/day/year

To:

To:

To:

To month/day/year

Direct Costs

Salaries

Fringe Benefits

Subtotal

Consultants

Conferences/meetings

Multimedia/publications

Equipment purchase

Office expenses

Travel

Other (list individual items that cost $5,000 or more below)

Total Direct Costs

Indirect Costs

GRAND TOTALV

Signature of Project Director:

Date:

Signature of Financial Officer:

Date:

Total amount of your organization’s or unit’s annual budget

$

Amount of proposed project as percentage of your organization’s or unit’s annual budget

%

Requested Corporation grant as percentage of your organization’s or unit’s annual budget

%