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Housatonic River Project Fund
2015 GRANT APPLICATION
Organization Overview
Name of Organization:
Legal Name, if different:
Mailing Address:
City, State and Zip Code:
Contact Name / Title:
Email Address:
Phone:
Federal Tax Status:
Federal Tax ID Number:
Number of years in existence:
Which of the 23 towns in the
HRP region do you operate in
or serve? (list all)
Required Attachments
1. IRS determination letter certifying status, if applicable.
2. IRS Form 990 or income/balance statements for most recent fiscal year (preferably audited).
3. If the grant is for a specific project, provide detailed budget for project, including income and expenses.
4. List of Board members and executive officers, including titles and affiliations.
Submittal Process
Please print the completed three (3) page application, attach the required information, sign and mail to:
HRP Fund
FirstLight Power Resources
P O Box 5002
New Milford, CT 06776
The 2015 Grant program closes on May 1, 2015. All grant applications must be postmarked by May 1, 2015
to be considered in this funding round.
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2015 GRANT APPLICATION
Organization Details
Please briefly describe your
organization's mission and
goals, and how they fit with
The Housatonic River
Project Fund mission and
goals:
Has your organization received
a grant or funding from
FirstLight Power or GDF Suez
in the last five years?
If yes, please provide details.
What is your annual operating
budget?
If your organization receives
support from Federal, State or
Local Government, list the
annual percentage
of budget received:
Are any FirstLight Power
Resources or GDF SUEZ Energy
North America employees
involved in your organization
(including officers or board
members and families)?
If so, please list names and
relationship to organization.
Page 2 of 3
2015 GRANT APPLICATION
Grant Request
Dollar amount requested
Total amount needed
to fund project
Funding pledges already
received:
Will the HRP Fund grant fulfill
matching fund requirements?
Describe in detail the purpose
or project that will be funded
by this grant:
How does this grant request
meet FirstLight Power's
investment priorities of
supporting Water Quality, Life
Safety, Environmental
Awareness and Energy and
Sustainability initiatives?
Describe the needs to be
addressed, the timeframe in
which the funding will be used
and who will benefit from this
project.
Authority and Signature: The undersigned certifies they are authorized to complete this application, and the
information contained therein is accurate to their knowledge. If a grant is awarded, it will be used only for the
purpose listed in this grant application.
Signature:
Name and Title:
Date:
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