A Grant Application Information Sheet must be be attached to all grant requests
*Print this form, fill out and return to address below
(click for guidelines)

GREATER LYNCHBURG COMMUNITY TRUST
P. O. BOX 714
LYNCHBURG, VA 24505
434-845-6500

INFORMATION SHEET FOR GRANT APPLICANTS

NAME OF APPLICANT ORGANIZATION___________________________________

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ORGANIZATION'S ADDRESS_____________________________________________

NAME OF EXECUTIVE OFFICER__________________________________________

NAME OF PROJECT CONTACT____________________________________________

TITLE OF PROJECT______________________________________________________

AMOUNT OF FUNDING REQUESTED______________________________________

PROJECT'S STARTING DATE____________AND ENDING DATE_______________

DESCRIBE OTHER EFFORTS YOU WILL MAKE OR HAVE MADE TO SECURE FUNDING FOR THIS PROJECT:____________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

_______________________________________ _____________________________
(Name of person completing this form.) (Title)

_______________________________________
(Date)