Organizational Information Existing Contact Organization Name * Street Address * Street Address Line 2 City * Postal Code * State/Province * Phone Number * Website * Email * Facebook Twitter Organizational Contact First Name * Last Name * Job Title * Phone Number * Email * Financial-Grant Information Is your organization tax exempt? If yes, please provide your EIN#? * Please provide brief statement explaining the history and past successes of your organization. * Please describe the goals of this project effort and your organization. * Please provide an estimate of the total number of patrons expected to be served by this project effort. * Estimated grant amount requested: $ * Please describe in detail how you plan to use this grant to advance your organization's mission. * Please share other grants pending or funding received from other organizations for this program or project by source and amount. * If this grant is awarded, please describe how many patrons/organizations would benefit because of this funding. * Would your organization be able to complete this effort without full or partial funding from FBT? * Yes No Please explain further. Please share any additional information that would assist FBT in making the grant decision. Past major achievements, individuals/organizations who can serve as reference, measures of success for this grant request, etc.