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Teton County Administrative Polices, NON-PROFIT FUNDING, Attachment A <br />c4Sl, OF <br />Requests are due in the Clerk's office on the <br />last Friday in May and should include all <br />required financial information. <br />Non -Profit Funding Request for Fiscal Year <br />Organization: <br />Contact Person: Title: <br />Mailing Address: <br />Phone: Email: <br />OVERALL AGENCY FUNCTIONS & GOALS <br />ANNUAL UNITS OF SERVICE and/or ANNUAL NUMBER OF RESIDENTS SERVED and/or <br />SPECIFIC PROJECTS or GOALS FOR THE COMING YEAR <br />BUDGET INFORMATION FOR ORGANIZATION'S FISCAL YEAR BEGINNING: <br />Total Projected Budget <br />for Upcoming Fiscal <br />Year <br />Amount from <br />Client Fees <br />% from <br />Client <br />Fees <br />Amount from <br />Fundraising <br />% from <br />Fundraising <br />Amount <br />Requested from <br />County <br />% from <br />County <br />Other Funds" <br />% from <br />Other <br />*Please use the space below to list the source and amount of your organization's OTHER funds, including GRANTS. <br />Page 1 of 2 <br />