Historic Preservation Education Grant
Application Cover Sheet

Grant ID No. __________________
Project Title:
 
Sponsoring Organization

Name:

Address:



Phone:

Project Director

Name:

Title:

Address:


Work Phone:

Fax:

E-mail:

Project Cosponsors (if any)









Budget
Grant

Cash Cost Share

In Kind Cost Share

Total:

$__________

$__________

$__________

$__________
 
Indiana Not-for-Profit Tax Registration Certificate number _______________________________

Official Signatures (original signatures, not photocopied, required on one copy; must be signed by 2 different people)

_________________________________________
Sponsoring Group Official (signature)

_________________________________________
Name and Title (please type) 		______________________________________________
Project Director (signature)


Submit to: Indiana Humanities Council, 1500 N. Delaware St., Indianapolis, IN 46202-2419

You MUST attach the Narrative Questions, Budget, and Required Attachments to this cover sheet.