4-H Grant Application Form Please complete the application and submit online prior to the deadline. Grant Category (check one):* Michigan 4-H Legacy Grant ($1,000) 4-H On-Target Grant ($500) Collins 4-H Youth Horticulture Grant ($500) 4-H Educational Garden Grant ($1,000) Project InformationProject title* Amount requested* What is the time frame for this project?*Please note time frame will determine when final grant report is due. September 1 to April 30. May 1 to August 30. Project Start DateList the specific start date MM slash DD slash YYYY Project End DateList the specific end date MM slash DD slash YYYY County/Counties served* Name of person writing this grant* Email of person writing this grant*A copy of the grant application will be sent to this email address. MSU Extension Staff Member InformationStaff name* Staff Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Staff PhoneStaff Email*A copy of this grant application will be emailed to this email address. 4-H Supervisor name 4-H Supervisor email address*A copy of this grant application will be emailed to this email address. Adult Volunteer InformationVolunteer Name Volunteer Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Volunteer PhoneVolunteer Email Teen Volunteer InformationTeen Name Teen Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Teen PhoneTeen Email Project DescriptionProject Description*Include a description of the project, what you plan to accomplish and specific kinds of activities and opportunities participants in your community will have as a result of this mini-grant.1. What are the measurable educational objectives of this project?*2. What aspects of this project make it distinctive and/or innovative for the target county/ies or community/ies?*3. Describe why the program or project is needed in your county or community*4. Where will programming take place?*After-school programCamp4-H clubSPIN clubAdult trainingOnline/virtualOtherIf other, please describe where programming will take place: 5. How many volunteers do you hope to reach?* 6. How many youth do you hope to reach?* 6b. Ages/age range of youth participants 7. Estimated number of contact hours:*Indicate the number of hours you plan to work with your audience for the duration of this grant. 8. What is the anticipated impact of this project on young people and/or your county or community?*9. Projects must include a strong focus on one or more principles of positive youth development.*Check the Michigan 4-H Guiding Principles that MOST apply to this project. (Do not check all.) 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. 10. List current and potential community partners that you will involve in the project and their role in the project.*11. Please list the names of other MSU Extension staff members who will be involved in your project: Be sure to include a description of HOW they are/will be involved in your project.MSU Extension Staff Member ListStaff NameCounty/Work TeamHow they are involved/role 12. How will you work with the media to promote this 4-H project?*BudgetWhat supplies, materials, resources and other items will you need to carry out your project?*Please complete the following preliminary budget. This budget should include all items listed above and reflect the total cost of the project, not just funds being requested in this proposal. Budget ListItem/DescriptionCostQuantitySubtotalTotal Total cost of project: Amount requested: If total cost of this project is not being requested in this proposal, please indicate how the remaining costs to carry out this project will be covered.Note: All grant applications are due by June 1.CAPTCHA
