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REQUEST FOR PUBLIC FUNDING <br />Non-profit agencies requesting funding from the City of Paris for projects that benefit the citizens of Paris must complete <br />the following information to be eligible for consideration (you may use additional pages, if necessary). In addition, please <br />submit with this form a copy of your agency's most recent financial statement or audit and a detailed budget for the <br />project. Agencies must also make a brief presentation on their project at a city council meeting. <br />Agency Name• ta1'Y\OLI( l,0ur16 ksmGi.!^1 A UJ(Ce5 Date: r( I1 ~10 <br />Agency Mailing Address: V•0 • 6 01 -7 <br />Agency Phone Number: 403 '18y-25i D Agency Fax Number:___~Q03~1gy"Zl0 1~70_1 <br />Contact Person :Q , 11; LtA Contact's 1itle: EXrC~~ v~~ rr~~or' <br />Contact's Mailing Address: SQX`nf, QS OIG1EI, <br />Contact's Phone Number: I ` <br />Contact's Email <br />Contact's Fax Number: <br />Name of Project: IM e,0..15 0✓x w~'1C~~ ~J <br />Location/Service Area of Project: ~Q.J~i S C~l-1~ t.Q,Yn0.1' Cac. Ln414 <br />Total Project Budget: <br />Number of Beneficiaries: <br />Total Amount Requested from City: $ I2l OOO.OL-) <br />Summary of Project: SG e. A4Q C.V1e8 1or1(Y) <br />Describe how your project will benerit the City of Paris and its citizens: <br />See- Ar4ac6ed <br />List other sources of funding for this project and the amounts: <br />See_ Pkcl% <br />Is a detailed project budget, 71~ylus lding columns and descriptions for allocations of city funding and the agency's <br />matching funds, attached? ❑ No <br />Is the agency's most recent financial statement or audit attached? [Yes ❑ No <br />Have you received funding from the City of Paris in the last five years for this or any other project? 04es ❑ No <br />If you have received previous funding from the City list the name of the project, the amount of the City's award, <br />and the year awarded: SC~ <br />City of Paris Revised 7/07/09 <br />90 <br />