WEEBGRANTPROGRAM COVERPAGE

AdministeringOrganizationMailing Address (Street, City, State,Zip)

ProjectDirector/ContactPersonDaytime telephoneareacode/numberFaxareacode/numberEmail

MailingAddress(ifdifferentfromabove)Street,City,State,ZipIf different addresses, send mailto:

Admin.OrganizationProjectDirector

ProjectTitle

GrantRequest:$

Project StartDate:

MatchingFunds: $Project EndDate:

PercentMatch:%

Number PeopleServed

(25%minimum)

WILegislativeAssemblyDistrictofAdministeringOrganization

WILegislativeSenateDistrictofAdministeringOrganization

Assembly District(s)of TargetAudience

Senate District(s) of TargetAudience

REQUIREDABSTRACT

Limit to space providedbelow.

CERTIFICATION

If this project is approved, the undersigned certifies that the organization will participate as indicated in the narrative and will provide the matching dollars by cash, services, or in-kind contributions between June 1, 2016 and December 31, 2016. None of these grant funds will be used to supplant existingfunding.

ProjectDirectorSignature

TitleDatesigned

PrimaryGrantWriterSignature

TitleDatesigned

SuperintendentWILL BE REQUIREDIFYOUR PROPOSAL IS SELECTEDFOR

FUNDING

Datesigned

WEEB (Revised2/16)

PAGE2WEEB1

PARTNER VERIFICATIONFORM
Electronic versions available onwebsite

Each of the undersigned certifies that they will participate in this project, that the specified obligations and responsibilities in this project will be met,andthattheprojectwillbeadministeredbythepublicagencyorcorporationdesignated.

ADMINISTERINGORGANIZATION

Organization’sName / Project Director’sName
ProjectTitle / TelephoneArea/No

WI DNR FORESTER (NOT REQUIRED FOR ALLPROJECTS)

Submittingintheschoolforestcategoryandtheproposalincludesanytypeofforestmanagementactivities(e.g.,removinginvasivespecies,harvestingand/orplanting, updatingamanagementplan),thelocalDNRforestermustsigntheconsortiumverificationpageevenifs/hewillnotbedirectlyinvolvedintheproject

Organization’sName / TelephoneArea/No.
Address (Street, City, State,Zip) / Supplying 1/3 or More of the TotalMatch?
(If yes, then CEO mustsign.)
YesNo
Name andTitle / Signature
 / Date Signed

PARTICIPATINGORGANIZATION(S)

Organization’sName / TelephoneArea/No.
Address (Street, City, State,Zip) / Supplying 1/3 or More of the TotalMatch?
(If yes, then CEO mustsign.)
YesNo
Name andTitle / Signature
 / Date Signed
Organization’sName / TelephoneArea/No.
Address (Street, City, State,Zip) / Supplying 1/3 or More of the TotalMatch?
(If yes, then CEO mustsign.)
YesNo
Name andTitle / Signature
 / DateSigned
Organization’sName / TelephoneArea/No.
Address (Street, City, State,Zip) / Supplying 1/3 or More of the TotalMatch?
(If yes, then CEO mustsign.)
YesNo
Name andTitle / Signature
 / Date Signed

Use a duplicate of this form if there are more than fourparticipatingorganizations.WEEB(Rev.8/15)

[Insert Narrative Here]

A. Project Title and Administering Organization Name

B. Project Description and Timeline

C. Target Audience/Need(s)/Justification of Need(s)

D. Dissemination

E. Project Evaluation

F. Staff Qualifications

G. Continuation

Wisconsin Environmental EducationBoard

WEEB 2(Rev. 9/07)Use reverse or additional sheet, ifnecessary.

BUDGET SUMMARY
AdministeringOrganization / ProjectDirector / TelephoneArea/No.
Budget CategoryExpense / ProjectActivity / GrantRequest
Round each item to wholedollars / Match
Round each item to wholedollars / Match Type (i.e., monetary, service, or supplies)
Source ofMatch
Salary/Honoraria
(NameorPosition)(Rate & timeperiod) / Activity
Fringe Benefits
(NameorPosition)(Rate & Percentage ofsalary) / Activity
Travel (mileage, lodging, meals)
(Name or no. of people)(Rate & distance, charge) / Activity
Materials/Supplies
(Be specific. Identify & quantify items.)
Non-Capital Items:
CapitalItems: / Activity
Other / Activity
TOTAL / Total Request
$.00 / Total Match
$.00