RRCA: Kids Run the Nation® Grant Application Form
Instructions: The program director should complete this application, sign it and return it to the RRCA National Office by st the grant application deadline of October 1 . Mail to: RRCA, 1501 Lee Hwy, Ste 140, Arlington, VA 22209 or fax to 703525-3890 or email to ExecDir@RRCA.org. Applicant Information Name of Youth Running Program: Contact Person: Address for Correspondence:
Street Address Apartment/Suite #
Today’s Date:
City
State
ZIP Code
Phone: Cell:
( (
) )
, Number of children served per year:
E-mail Address: Program website address: Requested Grant Amount (max $1000): $
Date Program was Founded:
Is this a new or pre-existing Please select from this list: New Program program? Is your organization a 501(c)3 nonprofit YES NO If no, is this a school run organization? program? Is your youth program part of an RRCA YES NO If yes, through what running club or event? club or event? Does your program serve both girls and YES NO boys? What age range does the program serve? Minimum Age: Maximum Age:
YES
NO
Is this a FREE program for participants? Please select: Yes
If no, what is the fee per participant? $
Please list other sources of funding for this program including sponsorship support and registration fees: Source: Amount: 1. $ 2. $ 3. $ 4. $ Other Sources:
Program Summary
Describe your program in this allotted space (approx. 300 words). Outline how you meet the eligibility criteria for a Kids Run the Nation Grant and how you propose to use the grant funds (be sure to review what a Kids Run the Nation Grant will and will not fund). Be sure to outline populations served and how your program is responding to the call to action to prevent childhood obesity in your community.
Program Director
Please provide a brief bio in the allotted space of the program director or individuals involved with the program:
Signature I certify that the information provided in this application is true. If awarded an RRCA: Kids Run the Nation Grant, I agree: The funds will only be used for the purposes outlined in this application or in accordance with the grant fund guidelines To promote that our program is a recipient of an RRCA: Kids Run the Nation Grant, and we may use the Kids Run the Nation® brand and RRCA logo for promotional efforts To allow the RRCA to promote our program nationally through print and electronic media and to use our program as an example for fundraising and awareness efforts for the Kids Run the Nation Fund and grants To expend the grant funds within 6 months of receipt or provide an explanation of when the funds will be expensed beyond 6 months To provide a written report within 6 months of receipt of the grant on how the funds have assisted our program If for any reason the program is cancelled before the funds are expended, I agree to return all unused funds to the RRCA: Kids Run the Nation Fund
Date:
Signature: Return this completed application by October 1st to the Road Runners Club of America. RRCA – Kids Run the Nation Application 1501 Lee Hwy Ste 140 Arlington, VA 22209 Fax: 703-525-3891 Email: execdir@rrca.org – Include” KRN Application” in the subject line