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<br />ALEX STERN FAMILY FOUNDATION <br />COMMON GRANT APPLICATION FORM <br /> <br />COVER SHEET <br /> <br />Date of Application: August 30, 2006 <br /> <br />(You may reproduce this form on your computer) <br /> <br />ORGANIZATION INFORMATION: <br /> <br />Legal Name afOrganization <br /> <br />Cass County Extension Office! Parent Resource Center <br /> <br />Address 1010 2nd Avenue South <br /> <br />City/State/Zip Fargo, ND 58102 <br /> <br />Telephone 701.241.5700 <br /> <br />FAX <br /> <br />701.241.5935 <br /> <br />Individuals Responsible: Sharon Query & Rita Ussatis <br /> <br />Name of top paid Staff Brad Cogdill <br /> <br />Title Office Chair <br /> <br />Direct dial Phone # 701.241.5712 <br /> <br />Contact Person Sharon Query <br /> <br />Title Extension Agent <br /> <br />Direct dial Phone # 701.241.5937 <br /> <br />E-Mail address of contact person Sharon.Query@ndsu.edu <br /> <br />Organization Description: (2-3 senlences) The Parent Resource Center provides research and knowledge based education to <br />parents and agency professionals who work with parents and collaborates with a organizations who desire that quality parent <br />education be available and delivered at their setting or other locations in the community. <br />Is your organization an IRS 501(c)(3) not-far-profit? ' Yes No <br /> <br />Ifno. is your organization a public agency/unit of government or religious institution: <br />fiscal agent (fiscal sponsor) Cass County Government <br /> <br />Yes <br /> <br />No If no, name of <br /> <br />AMOUNT & TYPE OF SUPPORT REOUESTED: <br /> <br />The dollar amount being requested: $ 14,350.00 over a three year period <br />Funds are being requested for (make sure the funder provides the type of support you are requesting, check the appropriate line) <br />general operating support capital Other: <br />I!roject support endowment <br /> <br />start-up costs <br />If a project, give project duration: <br />If operating support, fiscal year: <br /> <br />technical assistance <br />Month January Year 2007 <br />Month Year to <br /> <br />to Month December Year 2009 <br />Month Year <br /> <br />BUDGET: <br /> <br />Total annual organization budget: <br /> <br />$ 355,000 <br /> <br />PROPOSAL SUMMARY: <br /> <br />(If operating or start-up support related to the organization. Ifproject and other support. relate to the project.) <br />Project name (if applying for project support): Extending Parenting/Nutrition Information to Hard to Reach Audieuces <br />Please give a 2-3 sentence summary of the request: We would like to provide research based information at local <br />agencies/organizations for clients on a more continual basis. That information would include displays, Extension bulletins, Quick <br />Tics. and newsletters. <br /> <br />Geographic area served: - Population Served: Cass County <br /> <br />AUTHORIZATION: <br /> <br />Name of top paid staff and/or Board Chair (type): Signature <br /> <br />,~Co"'''' I&u~ <br />