2020 Partners for Change Submission Form

Instructions:

1. Click the link to download the 2020 Partners for Change application , and budget spreadsheet (a sample completed budget is available here). Complete these as separate Word and Excel files.

2. Fill out the form below.

3. Attach your completed application and budget.

For more information about the Partners for Change program, including guidelines, deadlines, and application support, click here!

Lead Applicant

First Name

Last Name

Title

Co-Applicant Name

If applicable

Title

Mobile Phone

Home Phone

Physical Address

Street

City

State

Postal Code

Project Site Main Address

Street

City

State

Postal Code

Please describe the project location

Website

Please provide a one sentence summary of the proposed project. (50 words)

Please write summary for future publication use if awarded. (100 words)

Please state the amount of your request

Partnership requests can be up to $75,000 over the three years in direct funds.

What is the proposed budget for this project?

Include total project budget size. For example: $55,000.

Application Form

25MB max

Budget

25MB max