Grant Application Form Page 5

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5. Budget
Specific amount requested: $_______________________
Please include an itemized budget for this project/program, and provide plans for other
sources of funding, if any. List requested, secured and/or matching grants and funds.
(Provide as much detail as possible. We need to see specifically how funds received from
RMHCCI will be used.)
6. Target Population
Please summarize your target population in measurable terms (i.e., who is the primary
audience, include how many children will be served, how old are the participants, where the
program is offered, and the geographic range of your organization). For example: 125
physically impaired children ages 6-12 throughout central Illinois or 1,000 underprivileged
children in Bloomington.

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