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<br />Date: <br />Project Name: <br />Applicant's Name: <br />Description of Applicant: <br />^ Public School ^ Individual <br />^ Private School ^ Other <br />^ Nonprofit Agency <br />^ Project sponsored by a Nonprofit <br />Agency (complete fiscal agent <br />information below) <br />^ Public Agency <br />Mailing Address: <br />City: <br />Project Contact Person: <br />Title: <br />Stat• Zip: <br />Phone Number <br />Fax Number <br />Start & Completion Dates: <br />Until: <br />Fiscal Sponsor Information (if applicable) <br />Name• <br />Contact Person: <br />Email Address <br />Address: State: Zip Code: <br />Email Address: <br />Title: <br />Altamont Settlement Agreement <br />Education Advisory Board <br />MINI-GRANT APPLICATION <br />Amount Requested: <br />Phone Number: <br />