Harney County Cultural Coalition 
P.O. Box 564
​Hines, Or. 97738
Harney County Cultural Coalition
  • home
  • About Us
    • Board Members
    • Committees
  • Application Process
    • Grant Application
  • 2017 Grants Awarded
  • Past Grants
    • Arts
    • Heritage
    • Humanities
  • Contact Us
​Harney County Cultural Coalition Grant Application Form
 
 
Project Name:                                                                                                                                                                 
                      
Applicant: ____________________________________________________________________________________
 
Contact Person: _____________________________________________________________________________________
 
Address: ___________________________________________________________________________________________
 
Phone: __________________________________ Email: ____________________________________________________
 
Amount Requested: _________________________________________
 
Project start date:                                                                                        Project completion date:                     
 
Does the Applicant have 501(c)(3) status? *  _________yes                                            __________no
 
If not, name of fiscal agent for project: _____________________________________________________________
 
Address: _____________________________________________________________________________________
 
Email:__________________________________________________________ Phone:________________________
 
Individual OR official of organization requesting grant funding:
 
_______________________________________________________________________________________________
Name (please print)                                                                                           Title
 
                                                                                                                                                                                           
Signature                                                                                                                                                    Date
 
 
Fiscal Agent, if needed:
_______________________________________________________________________________________________
Name (please print)                                                                                    Title
 
____________________________________________________________________       _________________________
Signature                                                                                                                                                    Date
Applications must be postmarked by November 1, 2017.  Late applications will not be accepted.
*Refers to an organization that has obtained tax-exempt status from the IRS under Section 501(c)(3) of the Internal Revenue Code.

Click the icon to the right ----->
to download and print this document
grant_application_proj_yr_2018.docx
File Size: 21 kb
File Type: docx
Download File

Powered by
✕