Please Read and confirm the following statements by signing BELOW

1. The activities and services for which this grant assistance is sought will be administered by or under the supervision of the applicant.

2. The funds received under this application will be used only for the specific project/program requested and will not be used for any political purpose.

3. The filing of this request has been authorized by the Board of Directors of the applicant. (Please include your current Board of Directors list with your application submission.)

4. The requesting organization is recognized by the IRS as a tax-exempt, non-profit organization with approved 501(c)(3) status. (Please include a copy of your most recent IRS Tax Determination Letter with your application submission.)

5. I attest that all of the information contained in this application and in any attachments included with this application is true and correct to the best of my knowledge.

Application