A. By submitting below, I certify that:
I have read and understand the Criteria and Guidelines set by The Premier Gives Back Foundation Committee. I have provided truthful, complete and accurate information on this applicant, and I have exhausted all other insurance and governmental funding sources before applying to TPGBF Committee
B. I represent and assure the Committee that, if I am granted an award, I will: Use the funds for the purpose state in this application; and promptly report in writing the TPGBF any change in the availability of Insurance and Governmental Funding sources that may affect my eligibility for funds.
I certify that, to the best of my knowledge and ability, the information included in the application is accurate as of the date submitted.