Benton County Economic Development

2004/2005 Grant Application

Please check the appropriate category for which you are applying:

___ Community ___ Housing ___ Business ___ Tourism

A. Application Information

1. Organization Name:

2. Name of Project:

3. Project Coordinator/Contact Person

Name:

Address:

City: State: Zip Code:

Phone:

Fax:

E-mail:

B. Project Description

1. Describe the Project (100 word maximum)

2. List any other financial cooperating partners/participating advertisers and the amount they are contributing to the project (100 word maximum)

3. Define (100 word maximum)

a. Who will benefit from the project?

b. Explain the anticipated economic impact:

c. Describe/Attach project description:

C. Timetable

1. Start Date:

2. Project Start Date:

3. Project Completion Date:

4. List activities involved in development

D. Budget and Amount Request

1. Total anticipated project expense. $____________________

2. Total anticipated project income.

a. Amount of grant request $_______________

b. Amount provided by applicant $_______________

c. Amount provided by other sources $_______________

- list sources and the amount they are providing

Total Project Expense $__________________ (equal to D1)

E. Signature of Project Coordinator and Date of Application

Signature of Project Coordinator _________________________________________

Date __________________________________

Send 1 original + 9 copies of the application form and support materials to:

Benton Development Group

303 - 1st Avenue

Vinton, Iowa 52349

Applications must be received in the office no later than 4:30 pm on July 14, 2004.