Farm Safety Grant – Application

Farm Safety Grant – Application

Click here for the program guidelines

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1 Organization Information
2 Contact Information
3 Project Information
4 Budget
5 Submit Application
Organization Information
Contact Information
Contact Person 1
Alternate Contact
Project Information
Is this project or program part of another event that you already do?
Budget

You may fill out the information below or upload a copy of your budget

Revenue

Total Revenue: $[(field26)+(field27)+(field28)+(field29)+(field30)+(field49)]

Expenses

Total Expenses: $[(field44)+(field43)+(field42)+(field41)+(field40)+(field39)+(field38)+(field37)+(field36)+(field35)+(field32)+(field45)+(field46)+(field47)]

Donations and Volunteer Hours Expected
Donations
Donated or in-kind items and services expected Approximate hours or value of service
×
(1)
Declaration
Confirm Totals

Total Expenses: $[(field44)+(field43)+(field42)+(field41)+(field40)+(field39)+(field38)+(field37)+(field36)+(field35)+(field32)+(field45)+(field46)+(field47)]

Total Grant Request: $[field49]

I declare that the information contained in this application is true and accurate. I am a duly authorized
representative according to our bylaws with financial signing authority for this application. I agree to provide a report which outlines how the funds were spent on this project, and which indicates that we complied with all conditions of the grant. I also declare that if a grant is awarded we will use it solely for the purposes outlined in this application.

Signatures From Two Officers of Your Organization is Required

If both officers are not available to sign the online application, you may upload a signed copy of the signature sheet found below.

Officer 1

SignatureI agree to the terms and conditions
(Sign Here)
Clear Signature

Officer 2

SignatureI agree to the terms and conditions
(Sign Here)
Clear Signature
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