New Jersey Historical Commission
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Project Support: Intent to Apply

Note: This declaration of intent for FY 2010 and FY 2011 must be filed electronically by 4:00 p.m. on September 1 of their respective fiscal years. The form and instructions for filing are available at the Commission's website, www.newjerseyhistory.org.
1. Project Title
2. Check one: Minigrant (no deadline) Projects
3. Name of applicant:
Street Address
City
State
Zip Code
County
Daytime Telephone
Fax#
Legislative District
Email Address
Website

Type of Applicant
Individual (applicants for teaching proposals must answer question 9)
Provide your Social Security Number:
Institutional (answer question 8 and for teaching projects, question 9)
Provide your Federal Employer Identification Number:
Provide your Charities Registration Number:

Type of Organization Historical Society Museum
Historical Site Library/Archives
County/Local Agency Other

4. In the space below, summarize the project. This summary does not substitute for the project narrative.

5. Grant period: to

6. Budget summary
a. Total requested from the NJHC $ Match (organizations only) $
b. Portion of line 6a for general operating costs of project : $
(only for organizations not eligible for general operating support grants)
c. Portion of line 6a for project use $
Note: Lines 6b and 6c must add up to line 6a

7. Institutional applicants must fill out this section
Project director Name
Street Address, City, State, Zip Code
Daytime telephone
Position with applicant

Authorizing official
Name
Title
Daytime telephone

Chief financial officer
Institution's annual budget: $
Number of members

8. Teaching grant applicants must fill out this section
Name of department chairperson
Title

9. Have you applied for or received other grants to help support this project? If so, please list them and the organizations that administer them.

10. If you have received a grant from the Historical Commission before, state for each grant the year of the grant, the amount awarded, and the title of the project.

Submit the completed application and all other materials to the New Jersey Historical Commission, PO Box 305, Trenton, NJ 08625. If you are using a service other than U.S. mail (e.g., Fed Ex, UPS) you must include the street address: 225 West State Street.