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Boulder <br />Citizens of the <br />sdentlfc & cultural <br />Facilities District <br />MakirroItPossible. <br />Save As: -' <br />Scientific and Cultural Facilities District <br />Tier III MINI Grant Application 2012 . <br />Applicant must have obtained eligibility from SCFD prior to completing this application. Organizations with any outstanding <br />Final Grant Reports or those submitted after February 15, 2012 may not apply. Detailed directions for completing this form are <br />on the SCFD website, www.scfd.org. SCFD staff will determine after the deadline if an application meets the minimum <br />submittal requirements. Incomplete applications will not be allowed for consideration. (See last page for more details.) <br />Organizations based in Boulder or Douglas Counties applying for GOS and have revenues of <br />$50,000 or less, in the most recent fiscal year MUST use this form. <br />No other counties will accept the 2012 Mini Grant Application. <br />County in which you are applying <br />Boulder <br />Official Organization Name. Do not type in all caps. <br />(■ Past SCFD funding recipient Organization type <br />C New SCFD funding recipient C Nonprofit C Government <br />Organization's legal DBA - Doing Business As name. Do not type in all caps. <br />Mailing Address <br />City <br />Organization Email <br />Organization Website <br />Federal Employee Identification Number (EIN /FEIN) <br />State <br />CO <br />Zip Code <br />Organization's Street /Physical Address (If different from mailing address) <br />City <br />State <br />CO <br />Zip Code <br />Primary Organizational Contact <br />Email <br />First Name <br />Phone Number <br />Ext. <br />Title <br />Alternate Email <br />Home County <br />Org. Main Phone Number <br />Org. Fax Number <br />Current Fiscal Year <br />Start <br />(MUST USE CALENDAR <br />click in box then, click <br />arrow box for calender) <br />Last Name <br />Current Fiscal Year <br />End <br />(MUST USE CALENDAR <br />click in box then, click <br />arrow box for calender) <br />Secondary Organizational Contact <br />Email <br />First Name <br />Phone Number <br />Ext. <br />Last Name <br />Title <br />Discipline 0 Art- Visual 0 Botany 0 Cultural History 0 Dance 0 Music <br />(' Natural History ! J Natural Science ('Theatre (`Zoology 0 Multi- Discipline <br />YOB .NAN FAIW GRRA O XES y <br />e Kll po ulate . nc dataas a ered,F of erpboxes rn application A <br />if_ <br />ou ty Request <br />erceftag - <br />Page 1 of 10 <br />