Medical Marijuana - Grant-coverletter

AMERICANS FOR SAFE ACCESS ADVOCACY GRANTS PROGRAM Coversheet  Date of application:_____________________________________________________ Name of individual or Organization:_______________________________________ ______________________________________________________________________ Purpose of Grant (150 words or less)_______________________________________ ______________________________________________________________________  ______________________________________________________________________ ______________________________________________________________________ Address:_______________________________________________________________ ______________________________________________________________________ Phone:________________________________________________________________ Fax:__________________________________________________________________ E­mail:________________________________________________________________ Name and title of contact for grant:________________________________________ ______________________________________________________________________ Detailed information about how you qualify as an ASA affiliate, ASA chapter, or  ASA member: _________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Is your organization a 501 (c)3?___________________________________________ If not please explain current status:________________________________________ ______________________________________________________________________

Total organizational budget for this year:___________________________________ Total organization budget for previous year:________________________________ Total project budget:____________________________________________________ Grant amount requested:________________________________________________