Community Promotional Fund Application
Rev. April 2020 Community Promotional Fund Application Page 1 APPLICANT INFORMATION:
Name of applicant: ____________________________________________________ Name of organization or group represented: ________________________________ Mailing address: ______________________________________________________ Contact phone number(s):
_________________________________
Email Address:
_________________________________
Non-Profit? Yes No If no, are you partnering with a non-profit:___________ PROJECT DESCRIPTION:
Name of Event: _______________________________________________________ Amount requested: $________________
What will the funds be used for and/or what are the waiver of fees for? ___________ ____________________________________________________________________ ____________________________________________________________________ When will the activity take place? ________________________________________ Where will the activity take place? ________________________________________ Why are the funds/waiver of fees/in-kind services needed? ____________________ ____________________________________________________________________ How many Barstow area residents are involved with this organization? ___________ How many spectators will watch this activity? _______________________________ Please describe how this activity will benefit Barstow. If additional space is necessary, please attach additional sheets:
______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Community Promotional Fund Application
Rev. April 2020 Community Promotional Fund Application Page 2 With this application, please attach the following:
1. A detailed budget stating the total cost of the activity or event, all sources and amounts of funding, and all expenses;
2. A description of the organization’s or group’s purpose or objective.
3. A copy of the organization’s non-profit determination.
By signing below, I declare that I have read the City’s Community Promotional Fund Policy and agree to all its terms and conditions. I agree that there is a formal process in place to conduct background checks on all employees and volunteers who work with persons under the age of 18 years and senior citizens.
I understand that an incomplete application will not be accepted and that the organization or applicant will not be considered for funding. (If the application is being submitted on behalf of an organization or school, an additional signature is required.)
_______________________________ ________________________________ Signature of Applicant Applicant Name (printed) & Date
_______________________________
School Principal or Organization
President/Director Signature
(if applicable)
**Please note that the fiscal year 2020-2021 budget will likely be impacted by the COVID-19 crisis. While the City recognizes the value of the Community Promotional Fund, awards will be contingent on the availability of funds.**