Name
_________________________________________________________________________________________________________________________________________________________
Address
_________________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________________
Are you resident of East Hampton, CT?
_________________________________________________________________________________________________________________________________________________________
Are you a 501(c)3 Organization?
_________________________________________________________________________________________________________________________________________________________
Are you seeking other funding?
_________________________________________________________________________________________________________________________________________________________
Purpose: Briefly state the needs or issues to be addressed with this project/program.
________________________________________________________________________________________________________________________________________________________
Goals & Objectives: Briefly describe the objectives, how the goals will be achieved, and timeline.
_________________________________________________________________________________________________________________________________________________________
Assessment: How will you know if the project/program is successful?
_________________________________________________________________________________________________________________________________________________________
Awareness: Please describe the manner in which you plan to promote/publicize your project and credit EHAcC for funding support.