This application must be completed in one online session. Please consider drafting your answers offline and saving them on your desktop. When you are satisfied with your responses, return to the website to cut and paste your responses into the online application form. You will then have a saved document with your responses that you can use to reference your application or to have in your records should you run into any technical difficulties. |
Organization Name
(this name will be used as the
name on the check, if awarded) : | |
Tax Exempt Status : | 501(c)(3)
501(c)(6) |
Tax Identification No. | |
New Applicant : | Yes
No |
Total Amount Requested : | |
Program Director |
Name : | |
Degree(s) : | |
Position Title : | |
Address : | |
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City : | |
State : | |
Zip : | |
Phone : | |
Fax : | |
Email : | |
Administrative Official |
Name : | |
Degree : | |
Position Title : | |
Address for sending check : | |
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City : | |
State : | |
Zip : | |
Phone : | |
Fax : | |
Email : | |
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Applicant Assurance: I certify that the statements herein are true, complete and accurate to the best of my knowledge. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil or administrative penalties. I agree to accept responsibility for the conduct of this project and to provide the required progress reports if grant is awarded as a result of this application. |
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Write a short narrative of the overall proposal. Do not use abbreviations. Your summary must be suitable for reading by laypersons. Briefly summarize the applicant's qualifications, plans for the proposal, and impact of the proposal in the area of interest. The executive summary must include measurable goals and why the AVMF is ideally suited to fund the proposed work. Must describe how the AVMF will be acknowledged if awarded. |
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All items over $500 must be justified. For example, if an item costs $50 each and ten or more units are needed, simply state the item needed, the unit price and the number of units needed. |
