HomeMy WebLinkAboutExhibitAPPLICATION FOR ECIVIS GRANTS
LOCATOR SYSTEM
OP AIN6
117
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IOLIAi WHOII ,
Organization Name:
17'
Board Chair:
Executive Director: Federal Employee ID it
Phone: Fax:
Email:
Address:
City:
State: Zip:
If outside City of Miami limits, please attach a brief justification for your inclusion in the program:
Estimated number of persons served in City of Miami annually:
Approved Users* (Name/ Phone #):
1.
2.
3.
*If more space is needed, please attach information on a separate form.
Have you ever received a grant?
Annual Organizational Revenue: Annual Revenue from Grants:
Annual Revenue from Contributions:
Please attach the following:
❑ 501(c)(3)
DList of Board of Directors
❑Form 990
❑ Most recent Financial Audit
DADA and EOE Policies
❑Letter of Good Standing from State Department of Consumer and Agricultural Affairs
OList and brief description of Programs
Disclosure: The undersigned hereby agrees to abide by the City of Miami POLICY AND PROCEDURE
FOR THE ECIVIS GRANTS LOCATOR SERVICE. Violation of this agreement may be cause for
termination of the eCivis Grants Locator service.
Signature: Date: