Project Funding Application Organization * The name of the organization you are representing Contact Person Name * First Last * Last Website Address * Address Line 2 City * State * AL AK AR AZ CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Postal Code Phone Number Email * Date Project description. * How does your project support the mission statement of this program? How many people will benefit from this project? Describe the long range community benefits of the project. What is the breakdown of the estimated project costs? * What funding amount is being requested? * What other funding sources are confirmed? (include $$ amounts) * What other sources will you be applying to for funds? Check all that apply * OC21 Foundation City of Orange City Sioux County Community Foundation Private Donation Campaign Our Own Funds Check all that apply Will there be any on-going operational costs required?