Application for Grants

Main Street Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact Person *

This is the person who is authorised by the organisation to make the application on its behalf

First Name

Last Name

Phone

(###)

###

####

Anticipated project start date *

MM

DD

YYYY

Anticipated project completion date *

MM

DD

YYYY

*

I acknowledge that I am authorised to submit this application on behalf of the organisation

All relevant fields in the application have been completed and are correct

The proposed project produces positive outcomes for the Eaglehawk community

Necessary number of Referrals are complete to be submitted. - See checklist at the top of this page for details.

I agree to complete all necessary Grant Evaluation processes when required.

I state that the information in this application and attachments is to the best of my knowledge true and correct. I will notify EEI of any changes to this information and any circumstances that may affect this application. I understand that this is an application only and may not necessarily result in funding approval. I confirm that if this application is approved I will agree to any audit process that Empowering Eaglehawk Inc. may require. I agree to providing Empowering Eaglehawk Inc. with an evaluation of this project by proposed date.