GRANT APPLICATION
Managing Information with Rural America
Grant Application
Community Information
Community:
Project Name:
Community Contact:
Phone:
Address:
E-Mail:
City/Zip Code:
Local Fiscal Agent:
Phone Number:
Address:
E-Mail:
b
City/Zip Code:
Project Participants (Name/Phone Numbers):
Submission of Applications:
All applications must be submitted to the MIRA Grants Committee before January 21,1999. Money will not be disbursed until a signed copy of the Assurances page is received by the MIRA Grants Committee, Each community must submit a separate application E-maii applications to eawaddle@yahoo.com or mail the application packet to: Beth Waddle. 806 Grove Ave, Coming IA 50841; (515) 322-4 [94. Applicants must complete all sections. Incomplete applications will be returned.
Funding Available:
57,500
SI 5,000
$15,000
SI 5,000
$5,000
515,000
$5,000
55.000
$7,500
515,000
Carlisle
Clarinda
Coming
Greenfield
Lacona
Lenox
Milo
New Virginia
Norwalk
Orient
Executive Summary/Overview
Briefly describe the proposed project.
MIRA Alignment
Briefly identify how your project furthers the underlying MIRA themes
Community:
Youth:
Technology:
Timeline/Work Plan
Complete the work plan on the following page. For each project milestone (major project event) identify the date of completion, detailed actions for completion, individual(s) responsible, and the desired outcome. Projects should not significantly deviate from this plan. [NOTE: All projects must be completed by August 15,1999. Communities that have not completed their project by this end date must repay their entire grant allotment,]
Budget Plan
Identify the major expenditures of your project. Prices must be based on actual quotes. Receipts are required for ALL items. Only 40% of the funds may be spent on equipment. Please list in-kind contributions and matching funds in your budget. While outside sources are not required, they are strongly encouraged. Projects must be completed by August 15. 1999, NO money may be expended before project approval or after August 15, 1999.
Project Work Plan
Date Detail Actions Individual Responsible Desired Outcome
Budget
Description of Item/Service Source of Funds/Source of Quoted Price/Quoted Price
Total Expenses Paid by MIRA Grant Funds: S15,000
Total Expenses from In-Kind Goods/ Services of Matching Funds; $39,850
Sustainability
Explain how this project will be sustained after MIRA
Statement of Assuranees
By signing this statement, the local fiscal agent agrees to complete all projects within the following requirements.
-All projects must be completed by August !999.
-Each project must proceed according to the work plan and budget outlined in this application. Major project changes
must be approved by the MIRA Grants Committee.
-The local fiscal agent must submit receipts for ail purchases.
-Each community must report the progress on its project by April I and July 1, 1999. A final progress report is due on
August 15. 1999. Progress reports must use the attached form.
-Receipts must be attached to each progress report (copies acceptable).
-No more than 40 percent of MIRA funds may be spent on equipment.
If MIRA projects are not completed by August 15, 1999. the W.K. Kellogg Foundation requires that the ENTIRE amount ofthc grant must be repaid by October 3 1, 1999.
To receive funds from the primary fiscal agent, the local fiscal agent must submit a signed request to the primary fiscal agent.
Funds will be released after project approval by the MIRA Grants Committee. No funds will be distributed until the primary fiscal agent rcceues the funds from the W.K. Kellogg Foundation.
Community:
Project Name:
Signature of the Local Fiscal Agent:
Date.
Signature of Community Contact: Date:
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