Amenity Grant Application Form.pdf - Roscommon County Council

Proposed Project
Description of Proposed Works:
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
How will the work be carried out?
(by Group, RSS, CE Scheme etc.)
_______________________________________________________________
Expected time scale of project: _______________________________________________________________
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Cost of Proposed Project
Please give breakdown of how proposed project with bee financed:
Total estimated cost of project:
Amount of funds raised locally:
Funding from other sources:
Amount of grant requested:
€_________________________________________________________________
€_________________________________________________________________
€_________________________________________________________________
€_________________________________________________________________
How will this project benefit your local area? _____________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Please state any other information which you feel is relevant to the Groups application: __________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Signed on behalf of the Group:
_____________________________________ ________________________ ___________________________________
Name Position Date
_____________________________________ ________________________ ___________________________________
Name Position Date
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Closing Date:
Closing Date for Receipt of Completed Application Forms: Friday, 26 th April 2013 at 4.30 p.m.
Completed Application Forms should be returned to: Community & Enterprise Dept., Roscommon County Council,
Roscommon West Business Park, Circular Road Roscommon.
Telephone: 090 66 37316; E-mail: amandas@roscommoncoco.ie; Web: www.roscommoncoco.ie