Larimer County 4-H Activity and Project Funding Request

Requests must be submitted a minimum of 30 days prior to the need for funding

Activity/Project *

Name of Person requesting funding *

First

Last

Date of Request *

Date of Activity/Project *

Location of Project *

Organization or person hosting/coordinating activity: *

Describe Project/Activity *

Form for gain):

Educational Value Statement (describe skills hoped to gain): *

Anticipated Number of Participants or List of Participants (Please indicate 4-Her, Leader, Coach, Chaperone) *

Itemized Proposed Budget *

What is the total cost of your activity/itemized? Upload pages/documents as needed

How much money are you requesting for funding assistance? *

Is Person requesting funding a minor (under 18) *

Name of person responsible for documentation (if submitting for a minor);

First

Last

Relationship to applicant: *

Person responsible for documentation Email *

Person responsible for documentation Phone *

Signature of Person Submitting Request Form *

First

Last

Please type your name above and then sign below.

Signature *

Clear Signature

Todays Date *

Supporting Documentation Upload if needed

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.

You can upload 3 files

Please upload any documentation needed above.

Upon completion, please click SUBMIT below to email this form to the Larimer County 4-H Foundation. We will confirm receipt of your application in a timely manner. For questions, please contact the 4-H Foundation at larimercounty4hfoundation@gmail.com