GRANT APPLICATION COVER SHEET

JENIFER ALTMAN FOUNDATION

Managing the Barbara Smith Fund and Programs for the Starfire Fund and the Upstream Fund

PO Box 29209, San Francisco, CA 94129 PHONE: 415-561-2182, FAX: 415-561-6480, E-MAIL: info@jaf.org

Organization Legal Name_____________________________________ Date______________________

Project Contact Person_______________________Telephone_________________E-Mail _______________

Mailing Address:_________________________________________________________________________

Fax________________ Web Site of Project and/or Organization____________________________________

Fiscal Sponsor Legal Name (if applicable)__________________________________________________

Contact Person_____________________________Telephone_________________E-Mail_______________

Mailing Address_________________________________________________________________________

Fax______________________Web Site______________________________________________________

Project Name__________________________________________________________________________

Goals_________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

Objectives or Work Plan__________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

Evaluation Criteria_______________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

Has this project been awarded support from other sources and/or funders?______________ If so, please list the

names of these funders and the amounts awarded:____________________________________________

Project Budget $______________Total Current Budget $_______________ Grant request $____________

Period Grant Would Cover________________________________Fiscal Year Start Date ______________

Name of person filling out this form:_________________________________ Phone:___________________


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