ECSEANDC Funding Request Form

Please complete the form below:

First Name

Last Name

Phone

Company/Organization

Mailing Address

Mailing City

Mailing State

Amount Requested ($)

Funds requested by

Project/Event Starting Date

Project/Event Ending Date

Specific Questions:

What purpose is the funding requested for?

Do you have a proposed text of a Motion for the SCNC Budget Committee's agenda?

Describe the project/event in detail:

What is the total budget for the project/event? ($)

Are there another funding sources or matching funds?

Please describe the additional funding sources or matching funds.

What is the timeline for the project?

How will this project/event be implemented, and by whom?

What would be the perceived/potential impact on the community, if we adopt the motion (pro and con)?

Are you aware of any potential conflicts of interest regarding the funding of this project for any Budget Committee and/or SCNC Board Member?

Which Budget Committee and/or SCNC Board Member poses a potential conflict of interest?

2 + 4 is

* So we know you are human.

Phone: (323) 750-0983

Visiting

8475 S. Vermont Ave.
Los Angeles, CA 90044

Location