“Making a Difference”

4-H Issues Conference Grants – Application Form

Grants funded by the Kentucky 4-H Foundation

To qualify for this grant you must have attended the 2017 4-H Issues Conference. $400 of this grant will be awarded at the beginning of the process with the remaining $100 awarded when the completed final report is received. Only grants that are filled out by Issues Conference youth delegates in their entirety will be considered. Incomplete or partial grants will not be accepted. Completed grant applications are due beforeJanuary 15, 2018 and the application process may be extended at the discretion of the State 4-H Office. Grants will be evaluated based on the development of the project, its scope and impact, planned evaluation and how you will report it (see application letter for more information). Please submit all materials in the order and manner listed below with this page first.

Please fill out the following application and submit (along with required documentation) to:
Chuck Stamper, Extension Special Projects Coordinator, 130 Robinson Road, Jackson, KY 41339

Phone: 606-666-2438 x237 Email:

Name: / County:
District: / Email:
Signature of Delegate: / Signature of 4-H Agent:
To whom should the grant be issued (the grant will only be awarded to a group or organization; it will not be awarded to an individual):

A. Grant Proposal

1. Title and Description of Project (Page 1, one page maximum)

2. Why have you selected this project? Why is this important to you? (Page 2, one page maximum)

B. Community Need & Support

1. Why is this program needed in your community? What group(s) and how many people will this program impact? (Page 3, 1 page maximum)

2. Who are the organizations and people that you will involve in this project? (Page 4, 1/2 page maximum)

C. Budget

1. Please provide a detailed budget on how the money will be utilized. This should be presented in a budget format with proposed income and expenditures. List any donations that will be received. (Page 5, Use the Budget Form Provided)

D. Evaluation

1. What are three goals that you have established that will determine the success of this program? Explain why you have selected these as your goals. (Page 6, 1/2 page maximum)

2. How do you propose to evaluate this program? (Page 6, 1/2 page maximum)

E. Promotion/Reporting

1. How do you plan to promote this program to the community? How will you communicate the success of this program? Youtube Videos & Displays are preferred.

(Page 7, 1/2 page maximum)

E. Refund

If a grant is offered and accepted by Delegate/Agent and no work is done on the grant, the funds MUST be returned to the 4-H Issues Conference account by October 1, 2018.

“Making a Difference”

4-H Issues Conference Grants – Proposed Budget

Budget Item
(list all items paid for by grant, paid for by outside funds and/or donated) / From Issues Conference Grant / Will this be paid by the Grant (G), Outside Funds (OF) or
Donated (D)?
(use the letter codes to indicate use)
Amount / Notes/Additional Information
Total / $ / $