Matching Grants Application

PROJECT TITLE*
PROJECT DESCRIPTION*
Please describe the project scope. Include specific equipment desired, surfacing type, and any non-play related items requested. If possible, please provide a sketch of your project outline and structures.
PROJECT GOALS AND OBJECTIVES*
Please state the overall goal for undertaking this project even if the project plays only a minor role in achieving that goal. Clearly state the objectives of the project and describe how they relate to the overall goal.
PROJECT PLAN
i. Activities planned to complete the project*
Describe major activities, actions, and procedures with a time table for your project
ii. Partnerships involved*
List groups or other organizations that will be involved in carrying out your project
iii. Administration and staffing*
Identify key individuals who will be involved in the project.
iv. Visibility and impact*
Describe how the project will be used to increase children’s activity levels and amount of play.
PROJECT BUDGET*
Please state your project overall budget. Please provide a breakout of estimated costs for each item.
PURCHASE OF EQUIPMENT, MATERIALS OR SUPPLIES*
1. Who will own equipment and materials? 2. Who owns the property where the site is located? 3. Who will be responsible for the maintenance and safety of the site?
TIME LINE*
Please provide an estimated start date, major milestones and completion date for your project.

PROPOSED FINANCING

Please list all requested financing.
Amount requested from American Playground Company*
Additional funding from other sources*
Total $*
SAFETY PLEDGE

Grantees must agree to schedule upon completion of the project and prior to use a CPSI certified playground inspection report to the American Fence Company Grant. Grantees must agree to conduct an annual CPSI playground inspection. All Grantees must agree to correct all non-compliant and hazardous issues within 30 days of the initial inspection and prior to use.
Consent*
I agree to the safety pledge
COORDINATING COSPONSOR

Primary Contact
Name*
First Last
Position/Title*
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Fax*
Additional Contact
Name*
First Last
Position/Title*
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Fax*
By signing below, we are agreeing to the following:
- All information contained in this application is true and accurate, to the best of my knowledge.
- The applicant has agreed to undertake this project as an activity of the applicant.
- The applicant agrees and will abide to terms of the safety pledge.
Consent*
I agree to the above statement.