Maine Outdoor Heritage Fund by tho13076


									                                        Maine Outdoor Heritage Fund
                                        Summary Information Form
Grant applicat ion deadlines are March 1 and September 1 of each year. A partnering organization must submit its
application to the sponsoring Natural Resource Agency 1 month prior to these deadlines. Natural Resource Agencies
should mail nine (9) co mplete copies of each application to: Caro l Gay, Secretariat, Maine Outdoor Heritage Fund, 37
Wiscasset Road, Pittston, Maine 04345. Please provide the follo wing informat ion electronically as well as a signed copy as
part of your grant application.

Application Date:                    Funding Category (1, 2, 3 or 4):            Resubmittal?

Is this a follo w-up to a previously funded project?
(If yes, include grant # and title)

Project Title:

Project Location (town and county, or statewide):

Name, Address, Telephone Number and Email of Project Coordinator (p lease list just one):

Name, Address, Telephone Number, and Email of sponsoring Natural Resource Agency

Names, Addresses, Telephone Numbers, and Emails of Partner Organizations (if applicab le) (A partner helps to plan or
implement the project):

Abstract of Project

Statement of Project Object ives:

Start Date:________________________________                     Co mplet ion Date:_______________________

Total Pro ject Cost:

MOHF Funding Request (Include agency administrative costs):

Cash Revenue Sources:_____________________                      In-Kind Revenue Sources:_________________

Signature of Co mmissioner or Director of Applying Natural Resource Agency                         Date

Sponsoring Agency: Please check one:
 “pass thru” sponsor                          “endorsing” sponsor (involved with project)

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