Please provide the following information in this order. For your convenience, you may choose to copy and fill out this cover summary or create your own one-page version using the headings listed below:

1. Legal name or organization, address, and name of executive director.

2. IRS 501(c)(3) non profit: Yes_____ No_____

3. Contact person, title and telephone number (if different from executive director).

4. Phone and Fax numbers.

5. Amount requested: $________________

6. Type of request (operating, project, capital, other).

7. Three (3) sentences summarizing the organization's mission.

8. Four (4) sentences summarizing your grant request and how it would further the goals of your organization.

9. List the proposal's target population, constituents and geographic communities.

10. Total annual organizational budget: $______________________ Fiscal year ends:______________

11. Project or capital budget (if applicable): $____________________

12. Period this grant will cover: _________________________ to ________________________

13. United Way affiliate: Yes_____ No _____

14. Amount of state or Federal funds: $__________________

15. If appropriate, please provide us with a proposal narrative that covers the reasons for undertaking the project.

Materials to be provided with your grant request:

1. Grant application.
2. Proof of 501 (c)(3) status.
3. List of Board Members.
4. Description of the organization, its history, overall goals and the rationale for the project for which you are requesting funds.
5. Complete budget for most recent fiscal year.

Submit to: The Nine Wicket Foundation, P. O. Box 6008, Falmouth, ME 04105 prior to April 1st .