June 4, 2015 Revision to Application.Pub

NEW ULM AREA FOUNDATION

Name Phone

Address City State _Zip

Contact Person

Telephone Email

Name of Project

Statement of Project Purpose

Geographic area to be served by project

Project Beginning Date Project Completion Date

Total Project Budget Amount Requested

Arts Education

Economic Development Historic Preservation 1. A description of the Project. Include purpose and objectives.

2. A description of the specific purpose of the funds requested.

3. Why the project is needed in the community. Include its significance and an estimate of the number of New Ulm area residents who will benefit.

4. Provide Board/Committee or Staff qualifications. Include all staff assigned to the project and describe their qualifications or experience in relation to the project's purpose, their probable availability for the duration of the project, and whether or not they can be replaced in the event they resign or are otherwise not available.

5. A statement advising how the grant, if made, can be evaluated with regard to the funds going to the agreed-upon purpose and the effectiveness of the project.

6. A detailed budget showing how the money will be spent. Include a summary of the project's projected revenue sources and, if applicable, the plans for continued funding of the project.

7. Provide a statement as to why the New Ulm Area Foundation support is requested, a description of what other efforts have been made to obtain required funding, and a list of approved, pending, and denied requests. Include the amount received to date from other sources. Has your organization applied for a NUAF grant before? Yes No

If so, when? Describe the Project

Amount Requested Was it approved?

1. List of names, occupations, and affiliations of your board of directors.

2. One copy of the U.S. Treasury letter certifying your organization as a 501 (c)(3) public charity. THIS APPLICATION WILL BE VOID WITHOUT THIS FORM

3. One copy of your most recent annual financial report.

4. Remember to SIGN at the bottom of this page.

Signature and Title Date