DP&L Right Tree Right Place
Environmental Grant Application
Submit completed application and direct any questions to:
Along with completed request form, please include:
· A copy of the municipality’s most recent audited financials or tax filing, a link is acceptable.
· Copy of the IRS determination letter classifying the municipality as tax exempt.
· The budget for this project.
· A completed IRS Form W-9. (blank forms available online at http://www.irs.gov/pub/irs-pdf/fw9.pdf)
Date of RequestName of Municipality/Community (check payable)
Street Address
City / State / Zip
Employer ID# (EIN)
Community Contact Person
Title
Phone / Alternate phone
Contact email
Community website
Does the municipality have special legal status under state law? If so, please specify i.e. 170(c)(1)
Describe mission or purpose of the Tree City USA designation for your municipality. (Additional pages may be attached.)
Description of the nature of this project. (Additional pages may be attached)
Amount of this request / $
Total budget for the project / $
Specific description of how grant funds will be utilized. (Additional pages may be attached.)
Have you received RTRP grant funding previously? If so when?
Will DPL receive anything in return for the Donation (such as recognition as a corporate sponsor)? If so, please specify.
Does the organization have any ties, involvement, or relationship with any DPL/AES person? If so, please describe. / No Yes
Does the organization have any ties, involvement, or relationship with any person or entity who has authority over pending DPL/AES business, such as being sponsored by a potential customer or business partner? If so, please describe. / No Yes
Does the organization have any ties, involvement, or relationship with any government official, such as having a government official or a relative of a government official on its board or acting as a sponsor or fundraiser for the organization? If so, please describe. / No Yes
Counties served by this project
Brief demographic description of population served by this program/project.
Signature