The Leon and Thea Koerner Foundation
Projects Committee
APPLICATION FOR A GRANT
(See attached Regulations)

Date

(Please use a typewriter.)
1.

Name of person making the application:

2.

If presented on behalf of an organization, give name of organization:

3.

Address:

4.

Is the institution making th e app lication registered as a charitable
organization under the Income Tax Act?

5.

Please give registration numb e r:

6.

Short title of project proposed: / .

7.

Outline proposal briefly, indicating its nature and objectives.
(Make a brief statement here; a lon ge r outline, with supporting date,
may be appended , if this seems de sirable .)
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8.

9.

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individuals or groups coop e rating in this work? Give details .

Estimate the ti me required to complete th is project or to finish the
ph ase of it with which this grant would be concerned:
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10.

If the proposed g r an t will not comp ! t e the p r o ject, what provision is
to be made for its continuation wh en th e re q uested fu nd s are exha usted ?
(Be as specific a s possible . )
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11.

What preparations have already been made to undertake the_work, or
facilities are now available with which to begin it?
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12.

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Give informat:ipn about any
or r lated { roj cts
applicant has asked for or has available from any other source:

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13.

ropose
u ge t.
ive spec1 1c
t es o f use and amounts):

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15.

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When appropriate , give na mes of other persons who may be consulted
regardi ng this projec t or the name s of any referees to whom the
Committee may refer:

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Signature of Applican t
Pleas e return the original to:
Mr. D. Lukin John~ton , Sec retary,
Proje c ts Commit tee,
The Leon and T. ea K0erner Found - LiLn,
Box 33859, Posta l Station "D"
Van co uve r , B. C.

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