Please state If application is for an individual or on behalf of an organisation.

If for an organisation please state position held. (e.g. chairman, secretary)

Individual / Organisation

First Name

Last Name

Address of individual or organisation

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

How many people in party.

Purpose of visit to Alexandria.

Date of visit (Start & finish dates to Alexandria)

Date, time & location of visit to the U.S.A.

Details (time, date) of all locations to be visited and the nature off the visit, not including Alexandria.

Address or addresses during visit to Alexandria

Amount of grant requested

Estimated total cost of proposed trip

Please detail breakdown of itinerary and contacts during visit to Alexandria.

If application is successful, to what purpose will the D.A.T.A. funding be used.

D.A.T.A. Dundee Alexandria Twinning Committee

Anticipated benefits to the individual or organisation from the visit to Alexandria.

Phone

Any other relevant information that will support application.