Buffalo, WY 27828
Phone Number: 307-555-5555
Fiscal Year: 2017
Project Begin Date: 1/1/17
Project End Date: 1/1/18
Application Status: Editing
Federal Tax Identification Number: 67-7757567
Business Type: School
Organization name associated with this Federal Tax ID:
Is the above organization a fiscal sponsor?:
Name of primary contact or fiscal sponsor: JC Rec District
Additional phone numbers or email addresses:
- Describe your club/organization by answering the following:
- What is the purpose of your club/organization?
- When are the club’s/organization’s regularly scheduled meeting dates and times (e.g. weekly on Thursdays at 4 p.m., or the third Thursday of every month?)
- If you do not meet regularly, how often and when do you plan to meet to implement your project?
- How many members are involved with your club/organization? 0
- What age group does your club/organization involve? all
- How many officials/sponsors are involved with your club/organization? many more
- What is the sponsor-to-member ratio? 90%
- What is the name and title of the adult primarily responsible for the club/organization? LL Inc - Knebel
- What is the purpose of your club/organization?
- What is the primary purpose of your project and how does it support the purpose of the JCRD, which is to “support
programs to increase community participation in a variety of recreational endeavors which are available to the public”?
Web & Community Outreach
- Specify what recreational opportunities will be provided to the public through your project and how many people
do you expect to participate in your project.
- Specify what recreational opportunities will be provided to the public through your project and how many people do you expect to participate in your project.
- Why should this project be funded?
- Describe in detail what activities will be involved in your project and how those activities relate to the purpose of your
- Please list any websites that pertain to this club, organization or project.
- Please list in detail any equipment or supplies that will be needed to implement/run the project, and the estimated
costs. Please be specific (e.g. “6 basketballs at $20 each for a total of $120” is acceptable, whereas “balls - $120” is
not acceptable). You may attach a separate list if necessary.
If your application could potentially impact structures or grounds of the Johnson County School District #1, including electrical, plumbing and HVAC, the application must be reviewed by the JCSD #1 Maintenance Department prior to submitting the application. A copy of the completed work order signed by maintenance personnel must be included with the application. Applications will not be considered without this documentation, and will be returned.
- Please list in detail any travel expenses the project will require. Please include departure and return dates,
destination(s), mode of transportation, number of participants (adults and minors) traveling, and any other pertinent
- Describe how you will advertise, promote and/or notify the public about your program to insure the public is aware of
the recreational opportunity.
- What kind of training, if any, will be required to implement/run the project?
- What is the name, title and relationship to the club/organization of the person responsible for implementing and
maintaining the project?
- Describe other financial contributions, in-kind, case or matching funds, which have been or will be made toward this
project, if any?
- If the project will extend past the grant period, what are the club’s/organization’s plan for sustaining the project?
Have you received or are applying for funding from one of the following?City: NoCounty: NoState: NoSchool district: No
|Project Revenues||Project Expenses|
|Total Revenue: $2.00||Total Expenses: $1,725.00|
Reminder: When completing a budget, the revenues and expenses must balance
Signature & Comments
|Note: You may supply additional information with this form as an attachment.|
Attach a timeline or action plan for your project. Attach a detailed projected budget for your project, itemizing all expenses. You may use the attached form, or develop any format that you think explains the project's budget. Additionally, if you are reapplying, you must attach a final report or status report.
By signing this application I acknowledge that I have read and will comply with all policies and procedures of the Johnson County Recreation District.
Note: JCRD funds are available because of a recreation mill levy in the county. This is made possible by an act of the legislature and action taken by the JCSD #1 Board of Trustees. These funds can be used only for community public recreation purposes. Additional information can be gained by attending any JCRD board meeting.
JCRD does not discriminate on the basis of race, color, national origin, sex, age, disability, political affiliation, religion or belief.