Required Information marked with * is mandatory

Please list my activity in your national calendar. Complete        ONLY program description and times and dates.
Funding request. Complete entire application.
In-kind support. Complete ONLY program description and        times and dates.

You will receive a planning kit that includes:
(Supplies are limited!)

1. Planning and Resource Manual
2. Publications
3. Poster
4. Reprints
5. Native American Technology Give-a ways

Applicant Information Organization * Street   City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas U.S. Virgin Islands Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Contact eMail * Your Web Address: Phone * Fax Federal Employer ID No. & Tax ID No. Tax Status Program Details IArea of Native American Technology Awareness Journey your support will support. Select Program Area High-Tech Sunday Business and Technology Day Research Day Family Tech Night Software and Hardward Review Day Computer Training Internet Day Corporate America Open House Other Description of Program. (Please tell us about your activity.) * Time and date of Program. Please tell us the times, dates and locations. * Budget. Give us a detail overview of your budget. You may list in-kind donations. Audience and scope of Program. Who will you reach? Discuss the demographics of the audience. Impact on the Community. What is the desired outcome of your Program? Promotion of Activity. How do you plan to promote your Program? Tell us about yourself and any supporting organizations. Please give us the names of companies and individuals who can speak about your organization and send two letters of recommmendations to us. Amount Requested. Select Request $500.00 $1000.00 $1500.00 In-Kind Support