Dow in Michigan Community Application

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Community Application

Name of the Organization^‡

501(c)(3) number^‡

Organization Description including mission and goals^‡

Organization Contact Information

Key Contact^‡

Address Line 1^‡

Address Line 2^‡

City^‡

State/Province^‡

Postal Code/ZIP^‡

Country^‡

Phone^‡

(Include Country/Area Code)

Fax

(Include Country/Area Code)

Nature of Effort:
Please describe the specific program/project that you would like the
initiative to support.

What is the title of the program/project for which the grant from the
Initiative is requested?^‡

What is the grant amount you are requesting?^‡

How many years are required to implement this project?^‡

Why is the program/project needed by our target community?
Your proposal must demonstrate that the program/project is addressing
a high-priority need in the target community and does not duplicate
existing programs.^‡

What is the purpose of the program/project and what results do you
expect to achieve?
Please give a brief description of the project. Keep in mind the Initiative's
focus and priorities.^‡

How will the program/project be implemented?
Please describe the steps/strategies required to launch the program and
how it will operate once it is up and running. Include dates for each step
and the number of hours per day/week/month that youth will participate
in the program.^‡

What is your plan for promoting this program/project to participants and
other necessary audiences?^‡

How will you sustain the program/project after the conclusion of the
Initiative's grant?^‡

Budget Allocations: Please describe the key costs for implementing and
operating the project.^‡

What other sources of funds are supporting the program/project or are
being solicited?
Please include the type of support and amount.^‡

How will you measure results and what is the timetable for measurement?^‡

Please email a signed request on the organization’s letterhead to fusuask@dow.com.

Enter the code as it is shown (required):

^‡ Required Field

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