AAUW Form

(Please fill out all sections and then scroll to the bottom and click submit)

(Please note that * denotes required field)

AMERICAN ASSOCIATION OF UNIVERSITY WOMEN TRUST

P.O. Box 10993, Fort Wayne, IN 46855

NONPROFIT ORGANIZATION PUBLIC SERVICE PROJECT APPLICATION

* Today's Date

*Nonprofit Organization

*Number of members

*EIN (Employer Identification Number)

for Tax Purposes(501,501c,501c3,etc)

*Project Title

*Grant Request $

Project Approved by Organization?

*If no, please explain

*Name

*Address

*City

*State

*Zip

*Email

Home Phone Please include area code)

*Business Phone Please include area code)

Project Description

1. Concise description of scope of project:

2. Evidence of need for project:

3. Goals and objective of project:

4. How organization’s members will be involved:

5 Initiation date of project and ending date of the project:

6. Public service benefit of project to community:

7. Name(s) and extent of participation of any other organization(s) assisting with project:

8. Specific plans and time schedule for accomplishing goals and objectives

a. Planning Stage

b. Implementation Stage

c. Evaluation Stage

9. Estimated budget showing itemized costs in priority order:

10. Sources of other grants held or applied for in support of project and amount of funding already assured:

11. Date(s) of previous grant(s) from the Fort Wayne Branch, American Association of University Women Trust:

*Digital Signature

Signature of Project Director

Date

Signature of Organization President

Date

If item 07 identifies any additional organizations(s) participating in the project, include the name(s) of the organization(s) and the signatures of the president(s). A maximum of two additional pages of supporting materials may be included. Please do not forget to click submit!