Cape and Islands License Plate Program
LARGE GRANT PROGRAM COVER SHEET
| DATE_____________________ | AMOUNT REQUESTED __________________ |
| TOTAL PROJECT COST______________________ | |
| PROJECT DESCRIPTION________________________________________________________ | |
| _______________________________________________________________________________ | |
| _______________________________________________________________________________ | |
| _______________________________________________________________________________ | |
| _______________________________________________________________________________ | |
| LEGAL NAME OF PRIMARY ORGANIZATION | |
| _______________________________________________________________________________ | |
| ADDRESS___________________________________________________________ | |
| ____________________________________________________________________ | |
| BOARD CHAIR | EXECUTIVE DIRECTOR |
| ___________________________________ | _____________________________________ |
| CONTACT PERSON AND TITLE | TELEPHONE NUMBER |
| ___________________________________ | _____________________________________ |
| CONTACT PERSON'S EMAIL____________________________________________________ | |
PARTNER ORGANIZATIONS |
|
| Partner _________________________________________________________________________ |
|
| Partner __________________________________________________________________________ | |
| Partner __________________________________________________________________________ | |
| Partner __________________________________________________________________________ | |
| BRIEF DESCRIPTION OF YOUR ORGANIZATION | |
| _______________________________________________________________________________ | |
| _______________________________________________________________________________ | |
| _______________________________________________________________________________ | |
| _______________________________________________________________________________ | |