Grant Program Application Form: Gillette and Wright Wyoming

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Applicant Information
Organization*
Contact Name*
Cell*
Telephone/Office*
Email*
Mailing Address*
Street Address City State ZIP Code
Program/Project or Event Description – Please Add Additional Sheet(s) If Needed Project/Event Information
Program/Project or Event Description*
Date(s) of Event*
MM slash DD slash YYYY
Location*
Amount Requested($)*
Non-Profit Organization*
- Yes
- No
Tax I.D. #*
Social Security. #*
Tax Exempt - Certificate Required*
This Information Is Required
Do you carry event insurance?*
- Yes
- No
If YES, Name of Carrier*
Policy Number*
Is this a one-time program/project/event or recurring?*
- one-time
- recurring
If recurring, how frequently*
Has the Campbell County CVB funded this event in the past?*
- Yes
- No
If YES, number of times*
If YES, amount received to date*
Is event public or private?*
- Public
- Private
Has venue/facility been secured?*
- Yes
- No
If so, please list*
Has hotel or campground been secured?*
- Yes
- No
If YES, Please list hotel(s) &/or campground(s)*
INFORMATION FOR TOURISM DEVELOPMENT PORTION OF APPLICATION - SCORING 25 POINTS MAX.
Anticipated # of out-of-town overnight visitors*
Anticipated # of attendees:*
Anticipated # of Room Nights (Dates, # rooms, # nights)*
Room Night History of Event (if applicable) (Dates, Hotel & Contact Name, # rooms, # nights)
How does this event contribute to the overall appeal of Campbell County as a preferred visitor destination?*
Request has the ability to generate lodging tax dollars, sales tax dollars/economic impact:*
Please list target markets that program/project or event will impact and how will it be marketed?*
When appropriate: request fills non-peak time periods:*
INFORMATION FOR EVALUATION PORTION OF APPLICATION - SCORING 25 POINTS MAX.
How does the program/project or event support your organization’s mission and the mission of the VISIT GILLETTE-WRIGHT?*
Total Projected Budget ($)*
Total Projected Revenue ($)*
Please attach budget with application*
Max. file size: 64 MB.
Any income coming from sponsorships ($)*
Any income coming from donations ($)*
Any income coming from admission fees ($)*
Any income coming from other grants ($)*
If you are requesting or anticipating receiving funding for this program/project or event from other sources, please list each source and the amount requested/anticipated (Amount Requested, Source, Amount Received)
Total Income/Funding Requested/Anticipated ($)*
Describe how grant funds would be used*
Describe how you plan to document overnight hotel/campground stays?*
Describe how you will evaluate the outcome of the program/project or special event*
When appropriate: request includes plan for overnight lodging industry stays.
Additional information/comments
Signature*
Title*
Date*
MM slash DD slash YYYY
*Please note that incomplete applications will be returned. Carefully read and follow grant guidelines.
** Grant Applications will be reviewed four times per year, the second Thursday of the month at the Campbell County Lodging Tax Joint Powers Board meetings in March, June, September, and December. Be sure to submit your requests as early as possible so they may be reviewed on a timely basis.
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