-
Name of grant project:_________________________________________________________________
- Amount requested:_____________
- Proposed Start Date of Project:_______________ Proposed Date of Completion:__________________
(Approved grant payments will not be disbursed until after June 2008, and may not be received until December 2008)
- Has the Applicant/Organization ever applied for a Maryland Horse Industry Board Grant?: ___No ___Yes
- If the applicant has previously received a grant what year(s) did it receive them?:__________________
- Name of Applicant/Organization:_________________________________________________________
- Address: ____________________________________________________________________________
- City/State/Zip:________________________________________________________________________
- Telephone(s): __________________________________________________
- Fax: _____________________________
- E-mail: ____________________________________________________________
- Website: ___________________________________________________________
- Federal I.D. number or evidence of not-for-profit or non-profit status: __ __ __ __ __ __ __ __ __
(If there is no federal I.D., contact person must provide his/her Social Security number)
- Contact Person: ______________________________________________________________________
- Address (if different from above): ________________________________________________________
- City/State/Zip: _______________________________________________________________________
- Telephone(s) (if different from above): _________________________
- Fax (if different from above): _________________________________
- E-mail (if different from above): _________________________________________________________
- Social Security # if there is no Fed. I.D.: __ __ __ __ __ __ __ __ __
- Brief Biography of contact person (maximum 150 words):
- Brief History of the Organization (maximum 150 words):
- Explain how the grant money will be used in this project. (maximum 150 words)
-
Check the box(es) that best describe(s) the goals of your project (maximum of 3 boxes):
Adult Education |
Equine Rescue / Rehabilitation |
Facility Development |
Green Space Preservation |
Historic Preservation |
Horse Health Awareness |
Promotion |
Research |
Therapeutic Equine Activity |
Youth Activity / Education |
Other ______________________________________________ |
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Summarize how your project will further one or more of the above goals. (maximum 150 words)
- Who will benefit from this project? (25 words or less)
- What geographic area does this project serve? ____________________________________________
- In what Maryland County is the Applicant/Organization based? (Skip if not based in Maryland) _________________________________________________
- Attach a brief breakdown of how grant funds will be used. List expenses specifically related to the
project and the cost of each expense (ex: Saddles -- $5,000; Newspaper ads -- $1,000; Fee for
announcer -- $400)
- Will you have other funding sources or matching funds for this project, or donation of in-kind
goods or services? ____ NO ____ YES
- If yes, please describe, including amount or dollar value of matching funds (100 words or less):
- Please list any project collaborators:
Name _______________________________________________________
Organization (if applicable) _______________________________________________________
Role in Project _______________________________________________________
Address _______________________________________________________
City/State/Zip _______________________________________________________
Telephone(s) _______________________________________________________
Fax _______________________________________________________
E-mail _______________________________________________________
Name _______________________________________________________
Organization (if applicable) _______________________________________________________
Role in Project _______________________________________________________
Address _______________________________________________________
City/State/Zip _______________________________________________________
Telephone(s) _______________________________________________________
Fax _______________________________________________________
E-mail _______________________________________________________
- How will your organization acknowledge this grant to its membership and/or the general public?
- Has your organization or contact person declared bankruptcy within the last seven years?
___ NO ____ YES
- Does the contact person or the organization have any outstanding liabilities with the State of Maryland?
___ NO ___ YES
List them:
Liability __________________________________________________ Amount $________________
Liability __________________________________________________ Amount $________________
Liability __________________________________________________ Amount $________________
Liability __________________________________________________ Amount $________________
NOTE: To be eligible for future grants from the Maryland Horse Industry Board, you must
submit a project report by December 30, 2008 (unless an extension is requested by
November 30, 2008), that describes what was accomplished and includes documentation of funds
spent (copies of receipts, contracts, etc.).
Name to make check payable to: _________________________________________________________
Address to mail check to: _______________________________________________________________
Signature of Authorized Agent for Organization: _________________________________________
Printed Name: _________________________________________
Title of Authorized Agent for Organization: _________________________________________
Date signed: _________________________________________
Proposal with original signature, plus 7 copies of entire proposal and attachments must be received no
later than 4:00 p.m. May 1, 2008 at:
Maryland Horse Industry Board
Maryland Department of Agriculture
50 Harry S Truman Parkway, Room 203
Annapolis, MD 21401
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