"A Century of Commitment to Research, Education and Conservation"


Grant Request Form - page 1

American Wildlife Conservation foundation, INC.
William C. Churchill fund – Karl T. Fredrick memorial Fund
CONSERVATION – EDUCATION – RESEARCH

John Hasenjager, Grants Comm. Chair
American Wildlife Conservation Foundation
5698 State Route 23
Cincinnatus, NY 13040
Email: jhas@frontier.com

Title of Proposal: _________________________________________________________ _______________________________________________________________________

Type of Project: __________________________________________________________

Name, Affiliation and Address of principal Investigator or Leader: _______________________________________________________________________ _______________________________________________________________________

Amount Requested: $ _______ Telephone – Work: (    ) ________ Home (    ) _________

Duration of Project: _______________________________________________________

Agency and Address of Agency to Receive Grant:
_________________________________________
_________________________________________
_________________________________________
_________________________________________

Signature of Applicant: _________________________________

Title: 
_________________________________
Date:
_________________________________
Email:
_________________________________

Signature of Supervisor or Agency Representative:
_________________________________

Title:
_________________________________
Date:
_________________________________

Mail original and 5 copies to Grants Committee (above) by February 1 (summer work) or by
August 1 (for next calendar year). In addition, please submit one (1) electronic copy of grant application and all subsequent progress and final reports.

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