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Consumer Advisory : Rondout Savings Bank does not and will not ask for personal information by telephone, email or over the Internet.  If you believe you have been fraudulently contacted please notify Rondout Savings Bank immediately at (845) 331-0073.

grant application

You may fill this form in online or print it out
and mail it in. To print place the cursor in one
of the form fields before selecting print or print frame.
The Netscape browser will not print the boxes.

Name of Organization
Address 1
Address 2
Address 3
Telephone   E-mail
Date founded
Chief Officer
Other Officers and Directors

Description of Project

Amount of grant requested
Amount of matching funds available
Total funds required for Project

Source of matching funds for project

Impact on community if project is not implemented

Number of individuals to be served by project
Geographic area to be served
If you are submitting this form online, telephone numbers of CEO and secretary must be provided in lieu of signatures.
Approval of Chief Executive Officer  
(Name)      (date)
Chief Executive Officer telephone number 

Approval of Board:

This application was approved by the Board of Directors of

(Organization Name)

at its meeting on (date)
Certification of Organization Secretary
(Name)    (date)
Secretary telephone number

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