Achill LDSIP

(Local Development Social Inclusion Programme)

Grúpa / Name of Group: _______________________________________________________

Ainm / Contact Person: _______________________________________________________

Post / Position in organisation: ____________________________Tel: __________________

Seoladh / Address: ___________________________________________________________

____________________________________e-phost / e-mail: _________________________

Dáta Bunaithe / Date Group Formed: ____________________________________________

Imeachtaí /Group’s Activities: __________________________________________________

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Uimhreacha Tacú / Numbers supported: Fir / Male___________ Mná / Female____________

Togra / Project: ______________________________________________________________

Sonraí / Details of Proposed Project: _____________________________________________

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Dáta tosú / Date project commenced / will commence): _______________________________

Costas / Estimated Total Cost: ______________________(PLEASE SUBMIT QUOTATIONS)

Airgeadú eile / Have you made other applications for funding? ________________________

Cé do / If yes, to whom? _______________________________________________________

Aon eolas eile ábharthacht / other relevant information (PLEASE ATTACH) ___________________________________________________________________________

Sínithe / Signed: _____________________________ Dáta / Date:____________________