Channel Islands Bicycle Club
Grant Request
Agency or Group Name:

Mailing Address:

Contact Person:					Phone #:

Tax I.D.#:

Total Amount Requested:   $ 
Does this request fall within the CIBC grant focus areas?  
Please check the area(s) that are most closely associated with this application.

Promoting bicycling as a means of:
    Recreation		Transportation		Health		Sport



Please submit the following to complete your grant application:

5 copies of this completed form
No more than 2 pages of supplemental narrative to support your request
5 copies of any brochures, newsletters, media articles, or other publications that describe your organization
IRS letter confirming your organization's 501(c)(3)  status

Mail to :  Channel Islands Bicycle Club
	      P.O. Box  6481
	      Oxnard, CA  93031











Name of project or agency:



What is the purpose for which this grant is being requested?









 Describe in detail the project this grant will support.  
	Be specific including individuals or groups assigned to 
	specific tasks, and due dates for your project.











Describe the total budget for the project, and how the funding from this grant will be spent.  Be as specific as possible.








What proportion of the total funding needed for this project does this grant represent?  









If this grant is for general operating support for an organization, what percentage of your organization's overall annual budget would this grant fulfill?






6.  What are your other major sources of funding?



What are the specific outcomes your organization hopes to achieve with this grant?


















8.  How will your organization publicize the grant and its results?