Community Grant Form

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COMMUNITY CONTRIBUTIONS PROGRAM
To support sustainability, community development and quality of life, General Moly, Inc. (GMI) plans to contribute
financially to communities in which it operates. In addition to financial contributions, GMI encourages and supports
involvement of its employees in organizations and activities to achieve the objectives of sustainability, community
development and quality of life.
This program is not intended to replace GMI’s contributions to physical improvements (housing and infrastructure)
necessitated by mine-related impacts. Proposed priorities for contribution are: education, social services and community
development. Some contributions may be classified in more than one category. Other sectors will be considered and may be
addressed as resources allow.

Education is considered to incorporate programs outside of the current school system, as well as opportunities within
the current school system that augment traditional or non-traditional facets of education. Examples could include
sponsoring a training program focused on development of in-home businesses (outside the current educational
system), tutoring programs (augments traditional facets of education) and clubs such as Future Business Leaders of
America and FFA (augment non-traditional facets of education).

Social Services are defined as programs that derive value from enhancing the services that support social needs.
Examples could include elderly, handicapped, drug abuse and indigent support programs.

Community development includes support of functions and programs that enrich the community culture or quality of
life. These can include sports programs, community events and facility development/support.
A Community Contributions Committee made up of at least five GMI employees whose jobs involve interaction with the
community and/or awareness of community needs and conditions, will meet on an as-needed basis, anticipated to be monthly,
initially. Contributions will be decided by this committee on the basis of the priorities established above and the basis of
need. Some degree of subjectivity is unavoidable, but the Committee is charged with making decisions on the basis of
overall sustainability, community development and quality of life. No contributions will be granted unless a request is made
by means of a Community Contributions Program Application for Funding form. Use the attached form or obtain a form
from www://generalmoly.com.
Please feel free to call (775) 753-MOLY(6659) if you have any questions. We look forward to considering your proposal.
Completed forms can be mailed to: Community Contributions Committee
General Moly, Inc.
2215 N. 5th Street
Elko, Nevada 89801
zspencer@generalmoly.com
The following organizations are ineligible for funding through the GMI Community Contributions Program:
-individual pursuits or stand-alone research
-feasibility studies
-Debt-reduction campaigns
-political parties or candidates
-religious organizations (except where they represent non-denominational community and social support
services)
-professional solicitors or third-party fund raising
-programs outside of the communities where we operate in Nevada
General Moly, Inc. 2215 N. 5th Street Elko, NV 89801
Phone: (775) 478-6000, Fax: (775) 753-7722, www.generalmoly.com - AMEX & TSX : GMO
Internal Use Only
Recommendation:
Approved by:
COMMUNITY CONTRIBUTIONS PROGRAM
Application for Funding
RECIPIENT
Name of Organization
Contact Person
Address
City, State, Zip
Phone
Fax
Tax Status
Tax I.D. #
Please submit your most recent financial statement and/or current budget.
AMOUNT
Amount you are requesting from GMI $
Total amount required for your organization/event $
OTHER DONATIONS
Have you approached other organizations for support?
Yes
No
List your major contributors and amounts contributed by each
PURPOSE
Does a portion of the money you raise go towards administrative costs?
If yes, what percentage?
Yes
No
%
Please classify your program below:
Youth
Arts and Culture
Environment
Recreation
Education
Health & Welfare
Civic Enhancement
Underserved Populations
Other
General Moly, Inc. 2215 N. 5th Street Elko, NV 89801
Phone: (775) 478-6000, Fax: (775) 753-7722, www.generalmoly.com - AMEX & TSX : GMO
How many people in this area will benefit directly from your efforts?
If this request is for a specific event, list the dates of the event
Are any GMI employees actively involved in your organization?
Yes
No
If yes, please list their names and functions within your organization
What is the primary focus of your organization?
How exactly will the funds you are applying for be used? List local projects or economic benefits.
_________________________________________
How will this project address community needs?
How will you measure the success of your project?
Please provide further background information on your organization or unique aspects of
this project. ________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Please list past projects your organization has provided that benefit the local community:
___________________________________________________________________________
___________________________________________________________________________
Signature:
Date:
General Moly, Inc. 2215 N. 5th Street Elko, NV 89801
Phone: (775) 478-6000, Fax: (775) 753-7722, www.generalmoly.com - AMEX & TSX : GMO
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