Grant Application

Grant Application

Organization & Contact Information

Name of Organization

Address Line 1

Address Line 2

City

State

Zip Code

Country

Phone (Home)

Phone (Mobile)

Taxpayer ID #

Total Agency Budget

Program or Project Details

Program or Project Budget

Amount Requested

Program or Project Title

Program or Project Start Date

Is this a new program or project for your organization?

Yes

Organization Financials

Organization's Fundraising Costs (as a dollar amount)

Organization's Administration Costs (as a dollar amount)

Organization's Fundraising Costs (% of total budget)

Organization's Administration Costs (% of total budget)

Projected Next Year's Operating Budget for Entire Organization

Next Year's Projected Fundraising Costs (as a dollar amount)

Next Year's Projected Administration Costs (as a dollar amount)

Next Year's Projected Fundraising Costs (% of total budget)

Next Year's Projected Administration Costs (% of total budget)

Date on Which Fiscal Year Begins

Date Incorporated

Principal Source of Support

Share the percentage of funding from any of these sources.

United Way

Foundations/Corporations

Individual Contributions

Government Contracts

Earned Income

Organization Narrative

Using the space provided, complete the following open-ended question fields.

What is the purpose of this request?

Why is this program or project unique? Why is it needed?

Summarize the organization's history, mission, and goals.

List any other organizations in the area with a purpose similar to your organization and describe collaboration, if appropriate.

What results do you expect from this program or project, and how will you measure them using numbers?

Describe your plan for sustaining the program (funding and other sources.)

Other funding sources and amounts applied for, reviewed, or committed.

Required File Attachments

Attach the following appendices in the file upload space below:

APPENDIX A: A complete budget for the project and/or program
APPENDIX B: The current annual operating budget. Include in-kind services and volunteer hours contributed.
APPENDIX C: Financial reports including Balance Sheet and Profit & Loss Statement, year-to-date.
APPENDIX D: The current Board of Directors. List names, businesses, addresses and occupations of each.
APPENDIX E: The current audited financial report. (optional)
APPENDIX F: The Foundation considers grant applications only from public charities as defined under the Internal Revenue Code and applicable regulations. An applicant must have obtained a 501 (c)(3) letter prior to submitting an application and must include a copy with this application. If the applicant is not required to have obtained a 501 (c)(3) letter, it must provide a copy of an IRS letter or a legal opinion verifying that the applicant is a public charity as described in section 509(a)(1), (2), or (3).

Uploads may be images (JPG, PNG, GIF), PDF, or document (DOC, TXT, RTF) files. Maximum upload size 4MB per file.

Appendix A: Program/Project Budget

Choose File

Appendix B: Current Annual Budget

Choose File

Appendix C: Balance Sheet and Profit & Loss Statement

Choose File

Appendix D: Current Board

Choose File

Appendix E: Current Audited Financial Report

Choose File

Appendix F: 501(c)(3) Letter