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Region II Mini Grant

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Region 1 - Zip codes beginning with 158, 160, 161, 163, 164, 165.
Region 2 - Zip codes beginning with 150, 151, 152, 153, 154, 155, 156, 157, 159, 166.
Region 3 - Zip codes beginning with 168, 169, 177, 178.
Region 4 - Zip codes beginning with 170, 171, 172, 173, 174, 175, 176.
Region 5 - Zip codes beginning with 179, 180, 181, 182, 183, 184, 185, 186, 187, 188, 195, 196.
Region 6 - Zip codes beginning with 189, 190, 191, 193, 194.
Member Group Grant Application
Region (*)
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Name of Member Group (*)
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Full Name (*)
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E-mail (*)
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Address (*)
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Phone (*)
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CEC Member Number (*)
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Requested Amount (*)
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Goals of the Activity (*)
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 (Purpose and Outcomes)
Description of the Activity (*)
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 (Including expected number of participants)
Budget (*)
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I accept responsibility for the disbursal of funds for the proposed activity.


*Following the event, the group shall submit to the Association Board of Directors (through the Regional
Director) a report detailing the event, a statement of expenses / revenues, photographs (if appropriate) and
any other supporting documentation. Submit within 60 days of the event.
Signature of Contact Person (*)
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 Typing your name into this box constitutes a legal signature.
Documentation
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Comments
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