APPLICATION FORM

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INSTRUCTIONS 

The mission of Africa Matters is to promote Conservation through Art, Education and Science, focusing on Africa, and to connect people and projects in the United States with those who can benefit in Africa and vice versa.

If you are requesting items to be purchased, please be as specific as possible as to manufacturer, model, vendors, price, specifications and any other information we would need to fulfill your request. 

It is assumed that the applicant will administer the project.  If the organization requires approval by an officer, that person should counter-sign the application where indicated and enclose a letter indicating approval of the project as described in the application.

Feel free to adjust the spacing in the application as seems appropriate (either by retyping or, if received electronically, by editing).

Requests for Assistance are reviewed and voted on by the Board of Directors as they are received.  We will respond to your request in a timely fashion.  If we cannot accommodate your request and know of other sources you might approach, we will so inform you. 

APPLICATION FOR ASSISTANCE 

Date of Submission____________

NAME of the Organization or Individual_________________________________

PART I.  THE APPLICANT.

A.        Describe the work you or your organization does in the field of Conservation.

B.         Length of time you or the organization has been involved in this work.

C.        What are your major sources of support/funding?

D.        Who benefits from your work?

PART II.  THE PROJECT.

A.        Type of Assistance Requested:

Financial___     Resources___  Information___  Networking____  Equipment____

B.         Describe the nature of the project.

C.        Location and timeframe of the project.

D.        How would the project meet the objectives of Africa Matters, as described

on the cover page?

E.         The amount/nature of the assistance are you requesting.

F.         Number, identify, and qualifications of any other persons involved directly in the

project.

G.        Date by which you need:

An answer____________

The requested assistance_____________

PART III.  VERIFICATION AND CONTACT INFORMATION. 

Signature of the Applicant________________________________

Title_________________________________________________

Date_________________

If appropriate

Signature of the responsible officer_________________________

Title_________________________________________________

Date_________________

Contact Information

Name____________________________

Mailing address_______________________________

                            _______________________________

                            _______________________________

Physical address______________________________

                             ______________________________

                             ______________________________

Phone:  Country code_____   Area code_____    Phone Number____________

            Alternate phones:

Fax Number___________________

E-mail address_________________

Please submit to

                        Ms. Wendy Blakeley, Director

                        Africa Matters

                        382  41^st Street

                        Oakland, CA 94610  USA