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Quick Grant Application

Page One

FOR OFFICE USE ONLY:
Grant Number:_____________________ Check Received:____________________
Check Number:____________________ Date Closed:______________________
Stipend:__________________________ Travel:____________________________
TOTAL:___________________________ Date of Event:______________________

2. Sponsoring Organization Name: *This question is required.

3. Sponsoring Organization Address: *This question is required.

Address
City
State
Zip

4. Phone: *This question is required.

5. Phone Type: *This question is required.

Home
Work
Cell

6. Project Coordinator Name: *This question is required.

7. Project Coordinator Address: *This question is required.

Address
City
State
Zip

8. Phone: *This question is required.

9. Phone Type: *This question is required.

Home
Work
Cell

10. Email: *This question is required.

11. Email Type: *This question is required.

Home
Work
Cell

12. Name of Presentation or Book: *This question is required.

13. Speaker/Discussion Leader Name: *This question is required.

14. Speaker/Discussion Leader Email:

15. Have you confirmed the program, date, time, and location with the presenter? *This question is required.

16. Event Location: *This question is required.

17. Event Location Address: *This question is required.

Address
City
State
Zip
County

18. Event Date(s) (MM/DD/YYYY Format): *This question is required.

19. Event Time(s): *This question is required.

20. Brief Description of Event: *This question is required.

21. Estimated Audience Size or Number of Books Requested: *This question is required.

22. Program Format(s) (meeting, banquet, classroom, etc.):

23. Publicity Plans:

By signing this form, the coordinator agrees to:

Supervise arrangements, publicize the program - acknowledge funding from SD Humanities Council, an affiliate of the National Endowment for Humanities - complete a final evaluation and cost share form - submit the appropriate application fee and certify that the sponsoring organization will comply with statues regarding nondiscrimination.

24. Program Coordinator Electronic Signature: *This question is required.

25. Date (MM/DD/YYYY Format): *This question is required.

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