Control # CHAPTER GRANT REQUEST FORM Date
See WCTU Grant Policy for details on the use of this form. Rev. 5 – 8/5/14
Chapter Name & Number:
Chapter President Phone and e-mail:
Project Name:
Project Location:
Total Project Cost: Amount You Are Requesting from WCTU:
Other Fund Sources :
From Other Agencies:
Property Owner Contribution:
Send check to: Name, Address, e-mail:
Chapter Project Coordinator and/or Requester:
Address:
Phone # & Email:
Cooperating Agencies Name:
Address / Phone / Email:
Description of Project- additional pages may be attached:
Est. Start Date: Est. Completion Date:
Describe the Educational and Outreach elements of the project:
Describe Chapter’s Volunteer and/or Financial Participation:
How will the project strengthen TU’s impact in the area:
Will the amount of this grant (plus other funding sources) cover the entire cost of this project?
Explain how the grant monies will be spent:
Describe any Chapter Publicity Efforts; including TU logos worn, TU materials, membership forms at the event?
Describe Participation/Cooperation of other Agencies or Organizations involved in you project
Is the project a Youth Event? ___Yes ____No If yes, the form is complete, if no answer remaining questions.
List the Projects Objectives:
Describe the Conservation Impacts of the project and how it aligns with TU goals:
Does the project have a clear plan to measure & evaluate expected outcomes:
Describe how the project improvements will be maintained over time:
Other comments on why this project grant should be approved.
Sponsoring Chapter President or Council Officer approval signature:
A summary report of the project's outcomes is required to be sent to the Council Chairperson and Grant Committee Chairperson within 60 days of project completion.
Send completed grant application forms to: Current Washington Council Chairperson and the Chair of the Grant Committee.
Council Chairperson, Rosendo Guerrero,
Grant Committee Chairperson, Tim Gavin,