⋞ Grant Request ⋟

Date	Click here to enter a date.
Agency or Group Name	Click here to enter text
Mailing Address, Street	Click here to enter text.
City, State, Zip	Click here to enter text.
Contact Person	Click here to enter text.
Contact Person Phone Number	Click here to enter text.
Contact person email address	Click here to enter text.
Federal Tax I. D. #	Click here to enter text.
Total Amount Requested	$Click here to enter amount.

Does this request fall within the CIBike grant focus areas? Please check the area(s) that are most closely associated with this application. Promoting bicycling as a means of: Check applicable box(s)
☐Recreation	☐Transportation	☐Health	☐Sport

Please submit the following to complete your grant application:

Email this completed form to: GRANTS.CIBIKE@GMAIL.COM

Scan and email the following documents, or Mail to:

Channel Islands Bicycle Club

P.O. Box 1164

Ventura, CA 93002-1164

No more than 2 pages of supplemental narrative to support your request.

A copy of any brochures, newsletters, media articles or other publications that describe your organization.

IRS letter/evidence confirming your organization’s tax exempt status. Example: 501(c)(3)

Please respond to the following questions:

Name of project or agency:	Click here to enter text.

What is the purpose for which this grant is being requested?	Click here to enter text.

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.	Click here to enter text.

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

What proportion of the total funding needed for this project does this grant represent? Click here to enter text.

If this grant is for general operating support for an organization, what percentage of your organization’s overall budget would this grant fulfill?	Click here to enter text.

What are specific outcomes your organization hopes to achieve with this grant?	Click here to enter text.

How will your organization publicize the grant and its results?	Click here to enter text.