Non-profit Funding, Attachment ATeton County Administrative Polices, NON-PROFIT FUNDING, Attachment A
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Requests are due in the Clerk's office on the
last Friday in May and should include all
required financial information.
Non -Profit Funding Request for Fiscal Year
Organization:
Contact Person: Title:
Mailing Address:
Phone: Email:
OVERALL AGENCY FUNCTIONS & GOALS
ANNUAL UNITS OF SERVICE and/or ANNUAL NUMBER OF RESIDENTS SERVED and/or
SPECIFIC PROJECTS or GOALS FOR THE COMING YEAR
BUDGET INFORMATION FOR ORGANIZATION'S FISCAL YEAR BEGINNING:
Total Projected Budget
for Upcoming Fiscal
Year
Amount from
Client Fees
% from
Client
Fees
Amount from
Fundraising
% from
Fundraising
Amount
Requested from
County
% from
County
Other Funds"
% from
Other
*Please use the space below to list the source and amount of your organization's OTHER funds, including GRANTS.
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Teton County Administrative Polices, NON-PROFIT FUNDING, Attachment A
BUDGET REQUEST JUSTIFICATION
Please describe exact benefits to Teton County taxpayers and provide specific deliverables with measurable results.
BRIEF REPORT OF PREVIOUS YEAR'S ACTIVITIES
if funding was received the previous year, please provide specific information about units of service, number of residents served and/or
projects/goals accomplished. You may also want to describe activities currently under way and any challenges or problems that have been
encountered.
CURRENT BOARD MEMBERS
Chair/President:
Vice Chair/President:
Secretary:
Treasurer:
Member:
Member:
Member:
Member:
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