4-H Grant Application Form Please complete the application (including the MSU Extension 4-H program coordinator or Extension educator’s signature). Grant Category (check one):*Michigan 4-H Legacy Grant ($1,000)4-H On-Target Grant ($500)Collins 4-H Youth Horticulture Grant ($350)4-H Educational Garden Grant ($1,000)Project InformationProject title*Amount requested* Project start date* County*Name of person writing the grant*Teen Volunteer InformationPrinted nameAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneTeen Email SignatureAdult Volunteer InformationPrinted name*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneVolunteer Email*A copy of this grant application will be emailed to this email address. Signature*MSU Extension Staff Member InformationPrinted name*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneStaff Email*A copy of this grant application will be emailed to this email address. Signature*1. What principles of positive youth development are reflected in your project?*Projects must include a strong focus on one or more principles of positive youth development. Check all those that apply. Youth develop positive relationships with adults and peers. Youth are physically and emotionally safe. Youth are actively engaged in their own development. Youth are considered participants rather than recipients in the learning process. Youth develop skills that help them succeed. Youth recognize, understand and appreciate multiculturalism. Youth grow and contribute as active citizens through service and leadership. 2. Describe your grant project:*Include a description of the project and what you plan to accomplish.What aspects of your project make it distinctive and innovative?*Describe the setting*Out-of-school program, camp, 4-H club, etc.Ages of project participants*Estimated number of contact hours*List the number of hours you plan to work with your audience .List your measurable objectives and the specific connection to a 4-H guiding principle*For example, outcome is linked to positive relationships, safety, youth engagement, youth directed participation, skill development, diversity and multiculturalism, or service and leadership.3. Describe why the program or project is needed in your community*4. What specific kinds of activities and opportunities will young people in your community have as a result of your grant?*5. In the end, what will be improved or better in your community or for young people as a result of your project?*6. What is the time frame for your project?*September 1 to April 30. Please list specific time frameMay 1 to August 30. Please list specific time frameSpecific time framePlease note: Time frames will determine when final grant report will be due if awarded. 7. List current and potential community partners that you will involve in the project.*8. Please list the names of other MSU Extension staff members who will be involved in your project: Projects that involve more than one county are welcomed.Name*County/4-H Work Team*9. What supplies, materials, resources and other items will you need to carry out your project?*10. Please complete the following preliminary budgetListItem/DescriptionCostQuantitySubtotalTotal 11. How will you work with the media to promote this 4-H project?*I am aware of and support the above grant application for this county and will ensure compliance of grant requirements if awarded. Supervisor email address*A copy of this grant application will be emailed to the supervising 4-H staff person. Note: All grant applications are due by June 1.