Community Project Application for Leadership in the Valley

Email address *
2019-20 PROJECT APPLICATION - DUE AUGUST 1, 2019
Organization Name *
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Program Name (if applicable)
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Contact Person & Title *
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Telephone (XXX) XXX-XXXX *
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Email *
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Primary Focus Area (choose one, see descriptions below): *
Other:
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Please state your organization's mission: *
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Please explain the project you are seeking assistance with. *
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Describe how this project contributes to advancing the selected impact and focus area: (What are you trying to achieve with your program and why is it important?)
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How long has this project been in your thoughts and what, if anything, has held you back from doing it?
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Are you already working on this project, if yes provide a brief description of the work so far:
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What impact do you hope this project will have on the population?
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Will the result of this work continue after the completion of this project?
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Will there be a need for the team to collaborate with other organizations, if yes list the organizations:
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Do you have a budget available for this project, if yes please define
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Do you believe this project can be completed within the eight month, 10-25 hours assignment? If not, please explain
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How does this project contribute to your organization's mission?
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Additional Notes (Site visit instructions, visit availability times, locations, ect…)
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A copy of your responses will be emailed to the address you provided.
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