Applicant Information










Partnership Details
 TYPE OF PARTNERSHIP (check one):
  1. TYPE OF PARTNERSHIP ACTIVITY (check all that apply):
Project Location, Activity and Timeline





Project Partners



Benefits
Please describe in detail the following benefits (attach additional sheets if necessary):



Qualifications

Additional Information (Optional)

Attachments
COSTS:
Please attach complete proposed partnership budget. The following items must be included in the budget narrative and accompany the project budget:
    a. Staffing Requirements
    b. How are you funding this service?
    c. What are your sources of funding?
    d. What is your capacity to manage the proposed activity?
    e. Total Project Cost
OTHER SUPPORTING DOCUMENTATION:
Please attach any of the following that you have:   
    a. Project Design
    b. Letters of Support
    c. Management Plan (Long Term or Short Term)
    d. Monitoring Plan (Long Term or Short Term)
    e. Insurance
    f. Other