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20 <br />ORANGE COUNTY Mini-grant APPLICATION <br />Please read carefully the description of the funding guidelines before completing and submitting <br />this form. In order to be considered for a grant, you must use this application form. <br />Names of re uestin em to ees and de artment: <br />Name De artment/Location <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />(Additional names may be added on a separate sheet as needed.) <br />Project Title: <br />Name of Contact Person: <br />Email Address: <br />Telephone Number: <br />AMOUNT OF FUNDS REQUESTED: $ (Provide budget details below.) <br />Project Plan <br />Health Promotion <br />Briefly describe how awarding this grant will reduce the risk factors (weight loss, high blood <br />pressure, stress) faced by most Orange County employees. <br />Project Design <br />Describe the project that you want to carry out, including: <br />What do you want to accomplish or change through your project? <br />