2019 Amplify Grant Date Organization Name Street Address Apartment, suite, etc City State/Province ZIP / Postal Code Where will your project have the greatest impact? (This will help us determine which RiseVT Program Manager contacts you.) ---Addison CountyBennington CountyChittenden CountyFranklin CountyGrand Isle CountyLamoille CountyOrange CountyWindham CountyWindsor County-serving, Windsor, West Windsor, Weathersfield, and Hartland"Windsor County-serving Springfield CONTACT PERSON Name (First Last) Email Address Phone FISCAL AGENT INFORMATION (THE FISCAL AGENT IS WHO THE CHECK WILL BE MADE OUT TO AND WHO THE W9 SHOULD BE FROM.) Name Email Address Phone Federal Tax ID Number Download a W-9 Tax Form CLICK HERE Upload Completed W-9 Form PROGRAM/PROJECT DESCRIPTION WE HIGHLY RECOMMEND THAT YOU COMPOSE THE BODY OF YOUR GRANT APPLICATION FIRST IN A DOCUMENT SUCH AS MS WORD, BEFORE CUTTING AND PASTING IT INTO THE ONLINE APPLICATION TEMPLATE Project Name Dollar amount requested Summarize your program or project in two sentences Provide a detailed description of your program or project. Describe which strategies in the Recommended Community Strategies and Measurements to Prevent Obesity in the United States from the Centers for Disease Control and Prevention your project/program is most aligned with. Find a summary of the CDC 24 strategies to reduce overweight and obesity here Find full details of the strategies by reviewing the CDC Implementation and Measurement Guide here Please provide a brief description of what RiseVT funding will pay for Additional supporting documents (if needed) Submit Start your application today!