LET'S PLAY APPLICATIONS

Grant Sponsor:  Western Elmore County Recreation District

245 East 6th South, Mountain Home, ID 83647

580-2377

David Freer Memorial Let’s Play Grant Application                                                                                                             Youth Recreation Grant Program

Name of Organization__________________________________________________________________________

Address______________________________________________________________________________________

Organization’s primary purpose/mission___________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________

Number of years providing youth (18 & under) recreation programming__________________________________

Number of years providing the youth recreation programs for which funds are requested____________________

Is the organization affiliated with any government agency?____________________________________________

Does the organization discriminate because of race, creed, color, gender, national origin or religion?  (The non-profit organization may discriminate based on gender if gender is a qualifying factor to determine whether the youth can participate in the activity.)_______________________________________________________________

Does the organization pay administrators, employees or coaches? (umpires/referees would be exceptions).

_____________________________________________________________________________________________

Is the request being made for an overall organization or for one team/group?_____________________________

Are the organization’s activities alcohol, tobacco & drug free?___________________________________

Attach to Application

• Names of all board members
• Name, title and contact information of organization’s primary contact for this grant
• Proof of Non-Profit Tax ID Number
• Proof of liability insurance
• Proof of number of youth involved: Previous year’s registration including team rosters with names and phone numbers
• Proof of number of adult volunteers involved: Previous year’s volunteer list with names and phone numbers
• Thorough explanation of how the Let’s Play grant money will be used
• Describe sources of the organization’s current income
• Additional information that will help the Let’s Play Committee and Let’s Play Board
• Completed signature page signed by the organization’s president

 

SIGNATURE PAGE

By signing this application for Let’s Play grant money from the Let’s Play Committee, Let’s Play Board and WECRD the__________________________________________________________ (name of organization) hereby acknowledges and agrees:

1. 1.that the facts are true and accurate;
2. 2.to post the Let’s Play logo on appropriate material, i.e. banners, flyers, posters etc.;
3. 3.to spend funds as presented in this application;
4. 4.to supply additional information if requested;
5. 5.to submit a report by December 31, detailing how Let’s Play grant money was spent and helped youth;
6. 6.that eligibility for future Let’s Play funding can be affected by the success or failure to accomplish all requirements.

 

Signed by______________________________________(name)_____________________________________(title)

Printed name and title ________________________________________________________________________

Email ___________________________________________________  Phone _______________________________

Date _____________________

 

APPLICATION DEADLINE:  Applications need to be postmarked by or hand delivered to WECRD office (listed above) no later than December 31.

Stamped date of receipt by WECRD_________________________________________________________________

 

Signature of WECRD representative who received application ___________________________________________