Funding Agreement Local Group Leader

Date

Local Group Name

First Name

Last Name

Name of Group Leader

First Name

Last Name

Requested funding amount:

Group leader's explanation of how the funding will be utilized:

File Upload- For additional supporting documents

Maximum file size: 20.97MB

Date funds are required:

Signature of the group leader:

Date

Signature of the authorizing board director and group coordinator:

Date

2741 Campus Walk Avenue, Building 500 Durham, NC 27705 919-383-7940 www.iands.org

Upcoming Events