CSB Programs

1. Applicant & Project Information
Project Name:		Amount of funding requested:
Brief Project Description:
Name of Lead Organization (project sponsor):
Mailing Address:
Contact Person:
Telephone:	Fax:		E-mail
2. Authorization
Acting as a duly authorized representative, I hereby affirm that the governing body of the below named organization has reviewed and accepts all the conditions described in the information packet and the organization wishes to be considered for funding by the Community Shelter Board.
Executive Director (or equivalent):				Date:
Authorized Signature:
Name/Title:
Program Director (or equivalent):				Date:
Authorized Signature:
Name/Title:
Finance Director (or equivalent):				Date:
Authorized Signature:
Name/Title: