Piedmont Bird Club Application for 20 20 Minigrant Grant Purpose : Grant must support a project that promotes the study and protection of birds and other natural resources in the Piedmont region See Information for Applicants on the PBC website for details. Amount: A one - time, non - recurring grant of up to $250 ; proposals for smaller grants welcomed Proposal Submission Deadline: December 6 , 201 9 . Grant selection to be confirmed by January 15 , 20 20 Projects will be awarded on the basis of (1) application clarity , (2) alignment with the PBC mission , (3) outcome spe cificity , and (4 ) reasonable costs plan Applicant contact information: Name ___________________________________________________________ ________________ _____________________________________ Mailing Address __________________________________________________________________ _________________________________ _______________________ ___________________________________________ _______________ ______________________________________ Phone __________________________ ____ Email_________________________________________ Role of applicant: o Organization representative/administrator o Teacher o Indi vidual/citizen o Youth o Other: ______________ Applicant age if under 18 years of age ________________ Faculty member, parent, or adult mentor if applicant is under 18 years of age Name____________________________________________________________________________ ___________________________________ School, organization , or relationship______________________________________________________ ______________________ Contact Email________________________________ _____________ Contact phone _________________________ ______________ *Note: if grant is awarded to an applicant minor , check will be directed to the parent or adult mentor. Amount requested $_____________ Project description: 1. A general description of the bird - related activity to be supported by this grant : _______________________________________________________________ ___________ _________________________________________ _____________________________________________ _____________________________ _________________________________________ 2. Location of the activity or project : ______________________________________________ ____ _________________________ 3. Intended use of the grant funds, listing expense items and estimated cost s: ___________ __________________ __________________________________________________________________________ _________________________________________ _______ ___________________________________________________________________ _________________________________________ 4. How d oes this project promote the study and protection of birds and natural resources in the Piedmont area ? _____________________________________ _________________________________________ ________________ ______________________________________________________________________________ _____________________________________ 5. Intended outcome :______________________________________________________________ _______________________________ 6. Projected timeline, beginning to completion of project: __________________________________________ ____________________________________ __________________________ ___________ 7. Are any other organizations being approached to fund all or portions of this project? (Y)*___(No)___ *If yes: • Provide background and funding details.__ _________________________________________________________________ _________________________ ______________________________________________ ___________________________________________ • Mini grant approval and award will be contingent upon confirmation status of additional monies needed to complete the project. 8. If awarded, would you be willing to do one or more of the following, if requested by PBC? (1) Provide picture s from the project for posting o n the PBC website; (2) provide a blog posting on the PBC website; and/or (3) p rovide a short description of/presentation on the project (5 - 10 min.) at a PBC meeting. Yes (Y) ___ No (N) ____ 9. How did you hear about this grant program__________________________________________ ______________________ _______________ ____________________ _____________________________ ______________ ____________________________________ ____________________________________ _______ ____________________________________ ______ Applicant Signature Faculty M ember , Parent, or Adult M entor S ignature (as applicable) ____________________________________ _______ ___________________________________ _______ Date Date Print , complete, and m ail application to : Piedmont Bird Club, PO Box 38833, Greensboro, NC 27438 Or, scan completed application and email to: Diana Bowman , PBC Minigrant Coordinator, at dianabbowman@gmail.com (note 2 b ’ s in email address) Application deadline: December 6 , 201 9 For questions, email Diana Bowman , PBC Minigrant Coordinator, at dianabbowman@gmail.com