TO: _____________________________________________, Grant/Awards Committee of  WVTRA

FROM: __________________________________________  Date: ____________________

1) Individual/Department/Organization making this request:

2) Description of event for which funds are requested with itemized budget.
(Attach outline of Project / Program; how it meets needs of Special Populations and/or WVTRA mission.)

3) Justification of need for funding. Also state reasons how WVTRA will be marketed in this event.

4) Amount requested from WVTRA:
( Attach acomplete itemized budget)

5) Signature of Project / Program manager and your immediate supervisor. ____________________________________________
Phone: ________________________________

6) Date Funds Needed:

7) Send To
WVTRA C/O Grant Committee
PO BOX 1444
Charleston, WV 25325

CONFIRMATION OF REQUEST

IMPORTANT: Confirmation of receipt of your request will be called or emailed to requestor. If you do not receive a confirmation of requesting within 10 working days after the request is sent, contact the WVTRA president.

Date Received: _________________________ Received by: _____________________________