Print this page, complete form, and mail to:

Rhode Island State Firemen's League
PO Box 255
Harmony, RI 02829

Deadline for Submission: close of business May 2, 2008

Date: ________________

Purpose and Dates:
____________________________________________________________
____________________________________________________________
____________________________________________________________

Objectives of Grant:
____________________________________________________________
____________________________________________________________
____________________________________________________________

Intended Beneficiaries and Numbers served:
____________________________________________________________

Standards:
____________________________________________________________
____________________________________________________________

 R.I.S.F.A.
 R.I.E.M.S.
 N.F.P.A.
 U.S.F.A.
 F.E.M.A.
 Other  ___________________________________________________

Amount Requested from R.I.S.F.L.: $__________
Amount Requested from other sources: $__________
Amount Authorized by organization for the Stated Purpose: $__________
Total cost of stated purpose: $__________

Name of Organization: _________________________________________
Address: ____________________________________________________
____________________________________________________________

Telephone Number: (___) ________ - ____________
Contact Person: ________________________________
Fax Number: (___) ________ - ____________
E-Mail Address: ___________________________________________


GRANTS AFTER APPROVAL MUST BE DISBURSED IN FULL WITHIN 2 YEARS

Submitted By:______________________________________
Signature of Chief or Training Officer:___________________________________

The League reserves the right to modify or reject all proposals.

.  .  .  .  .  Committee Use Only  .  .  .  .  .

 APPROVAL
 DISAPPROVAL
 OTHER

Modifications: ___________________________________________________
Comments: ___________________________________________________

Committee Initials: _______     _______     _______     _______

Committee Signatures:
___________________________________

___________________________________

___________________________________

___________________________________