a Splash" Environmental Grant Application (page 1 of 5)

It is important to fill out the application completely. If you have questions, please contact Desiree Pooley, City of Tacoma Environmental Services, (253) 502-2126 or . To be considered for a 2009 grant, your completed application must be postmarked by May 15, 2009.

Part A: Contact Information

Print Applicant Name: ______

Applicant Signature: ______Date: ______

Organization (if applicable): ______

Give a brief description of your organization (if applicable):

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Address: ______

Phone Number (day): ______E-mail Address: ______

Do you, or does your organization, have 501(c)(3) status? Yes No

If no, do you wish to designate an alternative grant recipient to receive the grant award so you won’t have to pay taxes on the grant award? Yes No

Designated Grant Recipient Name (if different from Applicant): ______

Organization (if applicable): ______

Address: ______

Phone Number (day): ______E-mail: ______

"Make a Splash" Environmental Grant Application – Page 2 of 5

Part B: Project Information

Project name: ______Amount Requested: ______

Brief description of project

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Project location/street address ______

Does your project require legal access permission (located on private land)?

YesNo

If access is required, attach a copy of a permission letter from the property owner.

Which method will your project use to prevent pollution and protect clean water?(check all that apply)

___ Education ___ Protection ___ Restoration

List specific things your project will accomplish through the methods checked above.

  1. ______
  2. ______
  3. ______
  4. ______
  5. ______
  6. ______

What will be the environmental effects of your project on the community?

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How does your project incorporate diversity in the community? (i.e. race, gender, age, disability, etc.)

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"Make a Splash" Environmental Grant Application – Page 3 of 5

Have you previously had a grant with the City of Tacoma? Yes No

If you have had a previous grant, what would you do differently or better this time?

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How did you hear about the Make a Splash program?

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Supplemental Information for the Grant Applicant:

A. If your grant application is approved, the following items (if they apply) must be obtained before beginning your project and prior to receiving any grant funds, but they are not required to be submitted with your application.

Contract: If awarded a grant, you or your designated grant fund recipient will be asked to sign a contract before beginning your project and prior to receiving any grant funds.

Permits: If your grant application is accepted and your project requires a permit (building permit, wetland development permit, or any other type of permit from the City of Tacoma or other governmental agency), you will need to obtain those permits before beginning your project and prior to receiving any grant funds.

Public agency approval: If your project is located on public land (for example, Metro Parks property, Tribal property, School District property, right of way, etc.), you will need to obtain public agency approval and a permission letter from the appropriate agency before beginning your project and prior to receiving any grant funds.

B. The individual items and activities listed in the budget under grant application Part C may be partially reimbursed as each activity is completed. Please submit an invoice form (an example is available on the grant Website – with receipts attached to request partial reimbursement of the grant amount for activities completed any time after the grant contract is signed. However, the entire grant amount will not be fully reimbursed until the project is complete and a final report is submitted and approved. Final report guidelines are available on the grant Website.

"Make a Splash" Environmental Grant Application – Page 4 of 5

Part C. Estimated Budget and Timeline

  • List the key activities or specific steps needed to complete your project, from first to last. If you need more space, you may use multiple copies of this table.
  • List costs, including necessary equipment, supplies, labor or other expenses. Labor may not be more than 20 percent of your total budget. Food costs may not be more than 10 percent of your total budget. The grant cannot fund digital cameras, video cameras or other electronic equipment. A disposable camera and film development may be included in the grant budget. If the designated grant recipient charges an administrative fee, you may include the fee in the grant budget.
  • All reimbursement invoices should be submitted by Aug. 31, 2009.

BRIEF DESCRIPTION OF EACH ACTIVITY / START DATE / END DATE / COST / LIST OF COSTS
Example: Transport 25 elementary school students (and 3 chaperones) to a creek site for a clean-up activity and on-site education. / 9/18 / 9/18 / $250.00 / School bus rental fee, gas and one driver.
TOTAL:

Note: Although the reimbursement costs assigned to each item/activity may vary from this budget estimate, items not listed on this approved budget will not be reimbursed.

"Make a Splash" Environmental Grant Application – Page 5 of 5

Part D. Project Evaluation Criteria

Explain how you will measure the success or outcomes of your project. Examples of measurement tools include interviews, on-site observations, photographs taken over time, videos, physical specimens, and other recordable documentation. This information should be included in the final report.

Example: Before the on-site clean-up and education activity, 25 youth will complete a one-page survey of knowledge of stormwater pollution impacts on creek health. Approximately one week after the trip, the youth will complete the same survey. We hope to see a knowledge gain of 50 percent or more. Details of the survey, including comments from the youth, will be in the final report. Before and after photos of the site will be taken to document the clean-up activity. In addition, we will repeat the trip in three months to observe the creek, pick up trash, talk about stormwater impacts, etc. We will repeat the post-event survey to document knowledge retention. We hope to see a retention rate of 95 percent or more.

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Prepare and submit a final report as soon as the project is done, no later than Aug. 31, 2009.

Document the project with photographs. If you use a digital camera, burn a CD with high-resolution images for use in future City publications or promotional materials or submit hard copy photos.

Official use only
Approved Signature: ______Amount: ______
Comments: ______
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______Date: ______