Clark County/City of Vancouver

1. 2018 Historical Promotion Grants Program (HPG) Application Form Clark County, Wash.

Clark County has established the Historical Promotion Grants Program (HPG) to promote historical preservation and historical programs and education.

Application Deadline: Sept. 15, 2017

Project/Program title: Organization:

Zip: Mailing address:

Title: Phone: ( ) Contact person:

Email: Exec. dir.:

Organization website:

Amount requested: $_ Total project cost: $_

Do you need more than one year of funding for this project/program? Yes No

Project/program timeframe: From: To:

Signature of authorized representative (required):

APPLICANTS MUST ALSO SUBMIT THE FOLLOWING:

 Supplemental forms, including: (1) Organizational description with board of directors’ information attached (2) HGP project/program budget or synopsis of organization’s current budget (3) Budget narrative.

 If applicant is a nonprofit, copy of applicant’s 501(c)(#) IRS letter of determination.

 An overview no more than one page in length of the proposed project or program and how it will increase awareness and education and better preserve, exhibit and/or interpret local history. Focus on specific objectives, benefits, funding resources, partnerships, publicity/marketing plan and success evaluation criteria as they align with the purpose, educational value, professional value, ADA compliance and/or other management issues addressed by this project or program.

NOTE: In completing your application, please note that the legislative purpose of this program is to “promote historical preservation or historical programs, which may include preservation of historical documents.”

Send or deliver SIX (6) copies of completed application materials by the deadline to: Jacqui Kamp, Planner III Clark County Community Planning P.O. Box 9810, 1300 Franklin St. Vancouver, WA 98666-9810 (360) 397-2280 j ac q ui. k a m p @ c l a r k . w a. g ov ORGANIZATIONAL DESCRIPTION

A bbre v ia t ed m iss i on s ta t e m en t:

C onc i s e h i s t o ry of o r g an i z a t io n :

O r g an i z a t io n al da t a : Number on the organization’s Board of Directors*: *Attach list of Board of Directors, terms of office, affiliations and contact information

Full-time Staff: Part-time Staff: Unpaid volunteers: Vol. hours:

Pr i m a r y d e m o g raph i c s s e r v ed :

Pr i m a r y g eo g raph i cal a r ea se r v e d :

B ri e f o v e r v iew of cu r re n t h is t o r ic a l p r es e r v a t i on / p ro m oti o n a c ti v i ti e s :

T y pe of s e r v ice ( s) p ro v ide d :

T op 3 O r g an i z a t ion a l r e v enue so u rc e s f rom prior f i sc a l y ear and p e r c ent of to t al o r g l. re v enue s : Source 1. Percent of Total Revenue: Source 2.

Source 3. Percent of Total Revenue:

Percent of Total Revenue:

T op 3 O r g an i z a t ion a l e x p e ndi t ure c a te g or i es f rom pr i or f is c al y e a r and p e r ce n t o f t o t a l or g l. expe n se s : Source 1. Percent of Total Revenue: Source 2. Source 3. Percent of Total Revenue:

Percent of Total Revenue: BUDGET* *Alternatively: Attach a copy of applicant organization’s budget for the current fiscal year

Name of project/program: Primary external funding partners for T HIS project/program (excluding Clark County): Partner: Contact: Phone: ( ) Contact: Phone: ( ) Partner: Contact: Phone: ( )

Partner:

The following cost information pertains ON L Y to the project/program referenced above.

External HPG Applicant Partner Total Funded Funded Funded Cost

Staff costs (aggregate):

Total Staff

Materials, supplies, equipment costs (itemize):

Total MSE

Services (itemize):

Total Services Other (itemize):

Total Other

Construction costs (aggregate):

Total construction

GRAND TOTALS Percentages *Note: Providing as much detail as possible about actual costs (such as by attaching a contractor’s estimate) will help evaluators to better review your proposal. Ballpark estimates make it difficult to evaluate as they tend to ask for maximum amounts (not actual costs) and don’t best answer how much the work is going to cost in terms of materials, equipment, labor, etc. Budget Narrative:

Succe s s e v a l u a t ion c r i t e r i a – H ow w ill y ou quan t ify a n d m easu r e t he s u cc e ss o f t h is p r o jec t / p ro g ra m ?

D esc r ibe st a ff co s t s :

D esc r ibe m a t e ri a ls, s up p l ie s, eq u ip m ent c o s t s :

D esc r ibe se r v i c es c os t s :

D esc r ibe o th e r c o s t s :

D esc r ibe con s tr u c t ion co s t s :

D esc r ibe co s t - sa v ing alte r n a t i v es y ou ha v e co n s i de r ed :

I f y ou intend to seek m ulti p le y ea r s of H PG f und i n g , p l ease ex p la i n sc o pe* o f t he pr o jec t / p ro g ra m :

*Note: If first year grant is approved, subsequent year grants will require a new application each year.