APPLICATION FORM (CHECKLIST ITEM #1)
State of California – Natural Resources Agency
DEPARTMENT OF PARKS AND RECREATION
Outdoor Equity Grants Program
APPLICATION FORM
PROGRAM NAME (include a name that best identifies the community, 50-character limit) REQUESTED GRANT AMOUNT $
OTHER FUNDING SOURCES (IF APPLICABLE) $
TOTAL PROGRAM COST $
COMMUNITY HOME BASE NAME and PHYSICAL ADDRESS
COUNTY OF COMMUNITY HOME BASE
APPLICANT NAME (entity applying for the GRANT) and MAILING ADDRESS AUTHORIZED REPRESENTATIVE, as shown in Authorizing Resolution Name (typed or printed) and Title Email address Phone
APPLICATION CONTACT, for detailed application questions (if different from AUTHORIZED
REPRESENTATIVE)
Name (typed or printed) and Title Email address Phone
GRANT CONTACT, for administration of grant if awarded (if different from Application Contact above) Name (typed or printed) and Title Email address Phone
GRANT SCOPE, I represent and warrant that this APPLICATION describes the intended use of the requested GRANT to complete the items listed in the attached GRANT SCOPE/Cost Estimate Summary Form.
I declare under penalty of perjury, under the laws of the State of California, that the information contained in this APPLICATION, including required attachments, is accurate.
Signature of AUTHORIZED REPRESENTATIVE Date
Print Name Title
15 ATTACHMENT 2_APPLICATION FORM