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Project Basics

Project Name: ['Sample Project - 0'] - Status: Editing
Organization: Sample Club
   Buffalo
   Sample City, Sample State Sample Zip
  Phone Number: 555-555-5555
  Email: sample@example.com 		ID: 0
Fiscal Year: 2017
Project Begin Date: 1/1/17
Project End Date: 1/1/18
Application Status: Editing
Federal Tax Identification Number: 00-0000000
Business Type: Sample Organization Type
Organization name associated with this Federal Tax ID: Sample Name on Tax ID Number
Is the above organization a fiscal sponsor?: Yes/No
Name of primary contact or fiscal sponsor: John Smith
Additional phone numbers or email addresses: 555-555-5555, john.smith@example.com

Project Details

Has this project been funded by JCRD in the past?  Sample Previously Funded
What is the total dollar amount requested from JCRD for this project?  $0.00
Is this a one-time request or will future funding be needed to continue this project?  Sample Project Type
  1. Describe your club/organization by answering the following:
    1. What is the purpose of your club/organization?
      Sample Purpose for Organization
    2. 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?)
      Sample Meeting Dates
    3. If you do not meet regularly, how often and when do you plan to meet to implement your project?
      Sample Other Dates
    4. How many members are involved with your club/organization? 99
    5. What age group does your club/organization involve? 10-15 Yrs
    6. How many officials/sponsors are involved with your club/organization? 99
    7. What is the sponsor-to-member ratio? 10:1
    8. What is the name and title of the adult primarily responsible for the club/organization? John Smith

  2. 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”?
    Sample Purpose of Project
    1. 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.
      Sample Recreational Opportunities

  3. Why should this project be funded? Sample Reason for Funding

  4. Describe in detail what activities will be involved in your project and how those activities relate to the purpose of your project.
    Sample Activities

  5. Please list any websites that pertain to this club, organization or project.
    Sample Websites Link

  6. 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.
    Sample Equipment Details
    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.

  7. 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 information.
    Sample Travel Expenses

  8. Describe how you will advertise, promote and/or notify the public about your program to insure the public is aware of the recreational opportunity.
    Sample Advertisement

  9. What kind of training, if any, will be required to implement/run the project?
    Sample Training

  10. What is the name, title and relationship to the club/organization of the person responsible for implementing and maintaining the project?
    Sample Main Person

  11. Describe other financial contributions, in-kind, case or matching funds, which have been or will be made toward this project, if any?
    Sample Financial Contributions

  12. If the project will extend past the grant period, what are the club’s/organization’s plan for sustaining the project?
    Sample Extend Date Passed

  13. Have you received or are applying for funding from one of the following?
    City: No
    County: No
    State: No
    School district: No

Budget

Organization: Sample Agency
Program: Sample Program
Project Revenues Project Expenses
Revenue Category Amount
Funds Requested from JCRD $0.00
City $0.00
County $0.00
State $0.00
School District $0.00
Fees $0.00
In-Kind Contributions $0.00
Donations $0.00
Other Grants $0.00
Other Cash/Funds $0.00
Other Revenue(Please describe)
Sample Other Revenue Explaination		 $0.00
Expense Category Amount
Staff Salaries (Employees of Agency) $0.00
Staff Benefits $0.00
Contracted Services
(professional services, bookkeeping, etc)		 $0.00
Repairs & Maintenance $0.00
Rental $0.00
Postage $0.00
Telephone $0.00
Advertising $0.00
Printing $0.00
Supplies $0.00
Equipment & Machinery (provide detailed list) $0.00
Dues & Fees $0.00
Other Expenses (Please describe)
 $0.00
Total Revenue: $0.00 Total Expenses: $0.00
Reminder: When completing a budget, the revenues and expenses must balance

Supporting Documents

No documents submitted

Sponsor Approval

Does this project require signoff from another party (e.g. Principal, designated city/county supervisor, etc.)?   No

Signature & Comments

Additional Comments:  
Date: Completed by:
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.

Dated:

NO SIGNATURE

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.