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NORTH SUBURBAN YOUTH ASSOCIATION <br />GRANT APPLICATION <br />1751 WEST COUNTY ROAD B, SUITE 107 <br />ROSEVILLE, MN 55113 <br />(612) 638 -4600 <br />ORGANIZATION /GROUP OR INDIVIDUAL MAKING APPLICATION: <br />DATE OF APPLICATION: <br />CONTACT NAME: <br />ADDRESS: <br />PHONE: <br />TITLE: <br />DESCRIPTIONS OF ORGANIZATION AND /OR INDIVIDUAL BACKGROUND: <br />FINANCIAL INFORMATION: <br />A. Organized groups must attach a budget or financial report. The NSYA membership <br />will review this application based on need and fund raising efforts. <br />B. Individuals requesting funding: <br />Identify purpose; <br />_ Group activity, explain <br />_ Personal, explain <br />_ Educational (other than scholarship) <br />Other <br />Attach detailed information describing how the funds you are requesting will be <br />used. <br />If this application is being made based on family need, provide a copy of last years <br />family tax return. <br />C. Organizations requesting funds: (must be youth related) <br />Youth activity <br />STATEMENT OF NEED <br />Attach a detailed budget and explanation of need. <br />AMOUNT OF MONEY REQUESTED: <br />$ (ONLY THIS AMOUNT WILL BE CONSIDERED) <br />Provide a itemized description of how the funds are to be used. (Attach three bid <br />proposals, if applicable. If bids are not included with this application, explain why <br />not). <br />Page 38 <br />