The Changing Lives Community Fund
2011-2012 Request for Proposals

PLEASE FILL OUT THE APPLICATION BELOW OR CLICK HERE TO DOWNLOAD THE FORM

Contact Information
Name of Agency/Organization:
Name of Primary Contact:
Title of Primary Contact:
Street:
Street (cont):
City:
State/Province:
Country:
Zip/Postal Code:
Phone:
Email:
Verify Email:
Agency Website Address:
Organization's Mission Statement
Organizations Mission Statement:
Proposal Information
Start Date:
End Date:
Brief Description (no more than 250 words):
Number of Individuals to Benefit:
Brief Description of Individuals to Benefit: include racial/ethnic and gender composition
Grant Amount Requested:
Agreement and Signature
By submitting this form you agree to the terms:	I certify that the information contained in this application, including all supporting materials, is correct to the best of their knowledge, and the applicant is eligible for funding by The Changing Lives Community Fund and Nevada Community Foundation.
Name:
Title:
Authorizing Official:
Date:

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The Changing Lives Community Fund2011-2012 Request for Proposals