Appropriation Amendment Request Form

The deadline to submit request for funding appropriations to Representative Torrey C. Harris' office is Noon on Monday, March 18, 2024. Please complete the following form. Representative Harris can not guarantee funding, but will advocate and speak in support of this appropriation before the Finance Committee and the members of the committee to do all he can to seek these funds you are requesting.

APPROPRIATION AMENDMENT REQUEST FORM

TODAY'S DATE

FIRST NAME & LAST NAME OF FORM SUBMITTER

EMAIL ADDRESS OF SUBMITTER

PHONE NUMBER OF THE PRIMARY CONTACT PERSON (MUST THE ORGANIZATION'S CHAIR, PRESIDENT, EXECUTIVE DIRECTOR OR SECOND IN COMMAND

NAME OF ORGANIZATION REQUESTING THE FUNDS

AMOUNT OF FUNDS REQUESTED

PURPOSE OF THE FUNDS & BACKGROUND INFORMATION (PLEASE PROVIDE ATLEAST 70 WORDS ABOUT THE ORGANIZATION AND WHAT YOU WILL USE THE FUNDS FOR:

DO YOU HAVE A LOBBYIST? IF SO WHO IS THE LOBBYIST FOR YOUR ORGANIZATION?

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

PHONE NUMBER OF THE ORGANIZATION

WEBSITE ADDRESS OF ORGANIZATION

ANNUAL BUDGET OF THE ORGANIZATION FOR CURRENT YEAR (FY 23)

ANNUAL BUDGET OF THE ORGANIZATION FOR PREVIOUS YEAR (FY22)

ANNUAL BUDGET OF THE ORGANIZATION FOR PRIOR YEAR (FY21)

PERCENTAGE OF ANNUAL BUDGET PAID TOWARD ADMINISTRATIVE COSTS IN ANNUAL BUDGET FOR CURRENT YEAR (FY23)

PERCENTAGE OF ANNUAL BUDGET PAID TOWARD ADMINISTRATIVE COSTS IN ANNUAL BUDGET FOR PREVIOUS YEAR (FY22)

PERCENTAGE OF ANUAL BUDGET PAID TOWARD ADMINISTRATIVE COSTS IN ANNUAL BUDGET FOR PRIOR YEAR (FY21)

AMOUNT OF ANY RESERVE FUNDS AVAILABLE TO THE ORGANIZATION (IF NOT APPLICABLE, ENTER "N/A"):

IS THE ORGANIZATION REGISTERED WITH THE TENNESSEE SECRETARY OF STATE (CHECK ONE):

YES

UNSURE

I CONFIRM THAT REPRESENTATIVE TORREY C. HARRIS WILL NOT DERIVE A DIRECT MONETARY GAIN FROM THIS ORGANIZATION DUE TO THIS REQUEST

Thanks for submitting! We’ll get back to you once reviewed.

Appropriation Amendment Request Form

APPROPRIATION AMENDMENT REQUEST FORM

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