October2008

Form EGA –1 Rev.

Story County 4-H Endowment Grant

Application

Sponsored by the

Story County 4-H Foundation

Due in the ISU Extension Story County Office by one of the following dates;

March 1, June 1, September 1 or December 1.

This form allows you to type as much information as needed to adequately answer questions. Read and follow directions on the Application Tips for a Story County 4-H Endowment Grant(EGA – 2 Rev).Review the Evaluation Tool (EGA—3 for criteria used in evaluating your application.

  • This application should be written by the 4-H'er or individual in charge of the project, program activity, or group and typed if possible. Submit one copy to the Story County Extension Office. Be as specific as possible with regard to plans and budget.
  • Include at least twoletters of support:They might be a person who will benefit from the project, a 4-H leader or adult volunteer, or acommunity memberrepresenting a group or organization with whom you are cooperating.

Name of 4-H Club or Group:
County: / Number of 4-H members:
Project chairperson, (4-H’er or individual) and complete address:
Phone: / E-mail:
Adult leader/contact person and complete address:
Phone: / E-mail:
Project Description: What are you going to do? Why did you decide to do it? Is there a need?Who will benefit and how? Does it have longevity? Be specific.
Read the Tip Sheet for helps on creating an action plan to present your goals, methods, involvement, and evaluation plans requested in the following sections.
Goals of Your Project: What do you want to accomplish with your project? State your goals in clear sentences, telling who, what, when, where, how.
Methods: How will you accomplish your goals? Include an action plan with a timetable listing who will do what and when for the project.
Involvement in Project: What part will participants (4-H youth/others) play in planning and carrying out the project? What will other individuals and groups in the community do on this project?
Evaluation Plan: How will you measure how successful your project was? How will you know if you reached your goals?
Proposed Budget: Give expected income and expense for this project for one year.
Expected Income / Expected Expenditures
Sources / Amount / Items / Amount
Endowment Fund Grant Request / $
$
$ / $
$ / $
$ / $
$ / $
*Total / $ / *Total / $
*The two totals must be the same.
Note: Fifty percent (50%) of the dollars for this project should be earned/raised/provided by individual, club/group, or organization requesting dollars. This can include in-kind gifts. A maximum of 25% can come from in-kind gifts.
Final Report: Required. A final report with pictures must be submitted to the Story County 4-H Foundation Board at the ISU Story County Extension Office 30 days after completion of the project.
Endowment Grant dollars must be used within one year of award. See Form EGA—2 Rev. for help.

Date of application:

Signature of project chairperson, individual, or 4-H'er:______

Signature of adult volunteer leader:

Comments by county Extension staff member:

Signature of county staff member

Extension programs are available to all without regard to race, color, national origin, religion, sex, age, or disability.