Organization Name:

Mailing Address:

City:

State:

Zip Code:

Telephone:

Fax:

Your Email Address:

Website:

Organizing Committee Members:

Name: Phone: Email:

Name: Phone: Email:

Name: Phone: Email:

Name: Phone: Email:

Name: Phone: Email:

Name: Phone: Email:

Name: Phone: Email:

Name: Phone: Email:

Name: Phone: Email:

Name: Phone: Email:

Executive Director/Contact Person:

Telephone:

Email:

Projected number of full-time/part-time employees:

Projected operating budget for first fiscal year:

Projected sources of income for first fiscal year (total should equal 100%):

Foundations: $ %

Corporations: $ %

Media Groups: $ %

Individuals: $ %

Associations: $ %

Special Events: $ %

Fees and earned income: $ %

Other: $ %

Please limit your responses below to the size of the text box.

Briefly describe the formation and mission of your organization i.e., why you want to start a news
council, why you think it is needed, and why you think it will succeed.

How do you plan to win media and community support for and participation in your news council?

How will you select your news council members, officers and chairman?

What are your organization's funding strategies for the next three years?

What are your contingency plans if you do not raise the necessary funds?

One year after receipt of this grant, how will you evaluate and measure how you accomplished your 12 month goals?

ATTACHMENTS

Please send the following doucuments (if available) to:

WNC
P.O. Box 3672  
Seattle, WA 98124-3672 

FAX - 206-464-7902

• Copy of IRS letter documenting your 501(c)(3) tax-exempt status or request.

• Projected operating budget for current year and the next two years.

• Most current balance sheet (for existing organizations).

• Audited financial statements (for existing organizations).

• Most recent annual report or publication describing your (existing) organization.