2002 Agendas and Packets - Laserfiche WebLink

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• `� � �� '4PPlicant Organizauon_ C., , �" �, U -F � �� e � t � i � i7 u ��.� c�.,. � � t s{�i� �S ` �� t'v� i �y � � � a�� a � �, � �� r� u4- ' Aaa�s: R:� �� E II� i�l ��% �:�"i� 3 Telephone: ( �S! ) i1 �'1 i-� �" =-� � � �1 E-mail Addc�ess: <- ��'1'�� • C u,*fi.G.� C� . f"�� .� iz ,t�+�►n •�� Fax (G S 1 ) �� ` � a % (� C�ief E�oecutive 4fficer. � ��.� � - � � �"S Project Contaa: �rul ` � �-+�r�l �� Projecc Tir1e: ,+��.�� G.�w � v�� -��.C. � S�" � L`I�.o�� `-�5�� --� Amount Requested: �P � � 6 � c' - . Pr�opased Staivng Date: --� �i:•`� U.��, ��- 0� 3 Ending Date: � C:- � ttLl.,u � �,� U u � All applications must include ihe dacumentatioa listed beiow and t}ie information requested in the narrative guidelines on the back of this form. h% -,� ✓` v y,. 1. A copy of the applicant organization's most recent fetter of exemption from the Intemal Revenue Service demonsirating thai it is aa orgaaization exempt from federal income tax under section 501{cx3) of the Internal Revenue Code, and stating whetl�er or not it is a private foundation_ 2_ Audit or yeaz-end financial statement for the most recently coznpleted fiscal year; the curreni year s operating budget; and current year-to-daie income and expense statement. 3. Names and affiliations (place of employment and/or other relevant coznmunity im�olvement) of the policy board responsible for the management of the applicant organization. 4_ Indication that this app3ication has been reviewed by the governing Board of the applicant organization and bas received its endotsement_ Where possible, a formal Board resolution to this effect should be submitted. In submitting this applicarion, the applicant agrees to the following_ 1. The applicant wi11 spend funds solely for the purposes stated in the application and will refund the unexpended portion of such iunds, if any. In addition, the applicant will provide interiFn and final reports as are required by #�e Faundat�an. 2. The applicant reaiizes tt�at payment of funds granted wili be at the convemeuce of the i�oundation, includang cancellation of the �ant and/or modification of previously a�eed upon payment se�edules should suc� cancellation or modification be deemed necessary hy the Foundation_ 3. The applicant understands �at the Foundarion, in researching this grant application, rnay review any and all of the informahon submitted as part of this request with advisors of the Foundarion's choosing, if deemed necessary by the Foundatioa 4. 'ILe applicant S�as made a determination regarding the applicability of the Minnesota Charitable Salicitation Act (MS3Q9) ar�d intends to corr�ly with the terms of this Act, if appropnate_ ! � ".�j � L✓ Signature: Chief E e tive Q$icer Date THE �'ainr I'auI F4UNDATION