Poland CEDC Special Event Grant Request

Section 1: Applicant Information

Organization Name

Website

Contact Name

Phone

Entity Type

Tax ID (if applicable)

Section 2: Event Information

Event Title

Event Location

Event Date (Start)

Event Date (End)

Set-Up Date

Event Summary List of Activities/Vendors

Permission for location use secured?

Yes No

Liability insurance secured?

Yes No

Section 3: Outreach and Engagement

List Partner Organizations List Any Charities Benefiting From the Event List Any Local Businesses Benefiting From the Event

Section 4: Revenue

Are tickets being sold?

Yes No

Source	Est. Revenue (USD $)
Ticket Sales	$
	$
	$
	$
Total	$

Section 5: Budgeting and Finance

Please provide estimated costs for each item and indicate the amount of grant funding requested for each.

Item	Estimated Cost (USD $)	Grant Requested (USD $)
Police Services	$	$
Fire/EMS Services	$	$
Recreation Dept. Support	$	$
Marketing & Promotion	$	$
Equipment Rentals	$	$
	$	$
	$	$
	$	$
Total	$	$

Section 6: Logistics Plan

Will attendees need to cross town or state roads?

Yes No

Where will vehicles be parked?

Will you have parking volunteers?

Yes No

Section 7: Marketing Plan

How will the event be advertised? (Select all that apply)

Social Media Local Newspaper Radio Flyers/Posters Town Website Email Newsletter Word of Mouth Roadside Signs Other (Described Below)

Additional advertising details or other methods: Will/How will the CEDC's support be acknowledged?

Section 8: Disclosure

Is any member of your organization or group currently employed by the Town of Poland or serving on any Poland municipal board, committee, or commission—whether in a paid or volunteer capacity?

Yes No

Section 9: Additional Comments

Section 10: Authorization

By signing below, I certify that all information provided in this application is true and accurate to the best of my knowledge.

Electronic Signature

Name

Date

Note: Clicking submit will open your default email client with the application details.
If your email client doesn't open, you can print to PDF and manually email to: PolandCEDC@polandtownoffice.org