GENERAL EE GRANT PROGRAM COVER PAGE
Administering Organization	Mailing Address (Street, City, State, Zip)
Eligibility: Corporation (nonstock, nonprofit) or public agency (check appropriate box). ¨ Public School District ¨ "Friends" Group ¨ Municipal Government ¨ Service Club ¨ CESA ¨ Conservation organization ¨ State Agency ¨ Youth Organization ¨ College/University ¨ Nature Center/Museum/Zoo ¨ Tribal Government ¨ Labor Union ¨ Cooperative Extension ¨ Professional association ¨ Lake district ¨ Other (Specify) ___________________ Wisconsin Nonprofit Corporation Number or LEA ID Number (Please do not use federal non-profit number or federal employer identification number). _____________________________________________
Project Director/Contact Person	Daytime telephone area code/number	Fax area code/number	Email
Mailing Address (if different from above) Street, City, State, Zip		If different addresses, send mail to: ¨ Admin. Organization ¨Project Director
Project Title
Grant Request: $ ________ Matching Funds: $ ________ Percent Match: _______ % (25% minimum)	Project Start Date:_______________ Project End Date:________________	What EE2010 goal does the project address? Select one. ¨I ¨II ¨III ¨IV ¨V ¨VI
WI Legislative Assembly District of Administering Organization ___________ WI Legislative Senate District of Administering Organization _____________ WI Legislative Senate District:		Assembly District(s) of Target Audience	Senate District(s) of Target Audience
	CERTIFICATION
If this project is approved, the undersigned certifies that the organization will participate as indicated in the narrative and will provide the matching dollars by cash, services, or in-kind contributions between July 1, 2007 and December 31, 2008. None of these grant funds will be used to supplant existing funding.
Project Director	Signature Ø	Title	Date signed
Primary Grant Writer	Signature Ø	Title	Date signed
Chief Executive Officer	Signature Ø	Title	Date signed
	REQUIRED ABSTRACT Limit to space provided.