American Sheep and Goat Center
Application for Grant
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Date Submitted: Date and Time Received by ASGC:
Legal Name:
Address: (give city, county, state and ZIP)
Name, telephone and email address of person to be contacted on matters involving this application.
Employer Identification Number (EIN):
Descriptive title of Applicant’s Project:
Proposed Project Start Date:
Proposed Project End Date:
Estimated Funding:
|
ASGC |
$ |
|
Applicant |
$ |
|
Local, State, or Federal Funds |
$ |
|
Program Income |
$ |
|
Other |
$ |
|
TOTAL |
$ |
Certification:
To the best of my knowledge and belief, all data in this application is true and correct. The document has been duly authorized by the governing body of the Applicant and the Applicant will comply with all Grant requirements if the assistance is Awarded.
Signature Date Phone
Name of Authorized Representative:
Title:
