Grant Inquiry Form

Organization Name

Name of Contact Person

Address

City

Contact Email

Contact Phone Number


EIN

Is your organization a public agency/unit of government
Yes
No

Focus Area
Healthy Living
Basic Human Needs and Services
Educational and Personal Development
Community Development
Location of Project
Within direct service area of Benton Cooperative Telecommunications Co.
Within impact area(Benton, Stearns, Mille Lacs, Morrison, Kanabee)

Total Organizational Budget

Total Project Budjet

Amount Requested-half the project budjet up to 25,00

Explain the time line of you project(400 characters or less)

Purpose of Grant(400 characters or less)

Project Description(400 characters or less)

Who will receive the greatest benefit from the funding?(400 characters or less)

How will these funds directly be spent(400 characters or less)

Explain, if there are any, other sources of funding(400 characters or less)