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6 <br /> 2004 Urban Initiative Proposal <br /> APPLICATION FORM <br /> Project name (five words or less) <br /> Location (City) Tree City USA Y N <br /> Name of Applicant Daytime Phone # <br /> Address of Applicant <br /> City State Zip <br /> Contact Person Daytime Phone # <br /> Fax# E-mail Address <br /> Contact Person Address (if different from above) <br /> Employer's Federal I.D. Number <br /> Brief Description of Project and Objective: <br /> Is this project currently funded through another entity? ❑ Yes ❑ No <br /> Was this project previously funded through another entity? ❑ Yes ❑ No <br /> DNR Funds Requested from budget work sheet $ • <br /> Applicant Share Provided from budget work sheet $ <br /> In-Kind Share . from budget work sheet $ <br /> Cash Donations from budget work sheet $ <br /> Total Amount of Project from budget work sheet $ <br /> By signing this grant proposal application form the undersigned agrees that all <br /> information is accurate to the best of their knowledge. <br /> Name and Title of Representative Date <br /> Signature of Authorized Representative Date <br /> 17 <br />