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E.O. Robinson Mountain Fund
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Grant Application Form
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Date
*
Name of Organization
*
Federal I.D. No.
*
County of origin in KY
*
Have you applied to us before?
*
— Select Choice —
No
Yes
Organization Address
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Address Line 1
Address Line 2
City
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Contact Person
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Contact Phone Number
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Contact Email
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Board Chair
President or CEO
Brief statement of organization’s history, mission, and goals:
*
Does organization have an endowment?
No
Yes
How is the endowment used?
support: ends Brief
No. of Employees & Volunteers
*
Geographic Area Served:
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No. of People Served by this project:
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Description of the project or activity this grant would fund:
*
Total cost of project
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Amount of this request
*
Do you receive funding?
*
State
Federal
Local
None
How will this project be sustained in the future?
*
Annual Operating Budget
Fiscal year begins
Fiscal year ends
Evidence of community support:
*
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