Grant Application

Please Note: This form must be completed in one session. Partially completed applications cannot be saved and returned to later. We recommend that you review the entire form and gather the relevant information before you start entering your data.

All fields are required unless noted otherwise.

GROUP INFORMATION

Legal Name of 501(c)(3) Organization

Legal Address of Organization

What is the purpose of your organization?

CONTACT PERSON INFORMATION

Contact Person Name

Title

Phone Number (daytime) - Please enter as xxx-xxx-xxxx

Phone Number (evening) OPTIONAL

Email

PROJECT INFORMATION

Grant Title

Brief Description of Grant

Overall Budget for Project

Are you receiving money from other sources for this project?
yesno
If "yes" please describe

PROJECT PURPOSE & OBJECTIVES
Why did you select this project?

What are your measurable objectives?

Who and how large is the target group?

Will any others in the local community be impacted?

ACTIVITIES SUPPORTING YOUR MEASURABLE OBJECTIVES AND PROJECTED TIMELINE
List significant activities and project dates you will follow to make this a reality.

BUDGET DETAILS
Include specific cost and sources of materials, equipment and supplies. Additional categories could include transportation, postage/mailing, photocopying, etc. PLEASE REMEMBER – money CANNOT be used for any kind of stipend or salary for an individual. You may manually enter the information below or upload your budget document if you prefer.
Detailed Budget

PROPOSED EVALUATION PLAN
What are your plans for monitoring and evaluating your objectives?

REQUIRED ATTACHMENTS
Please upload a copy of the following three files:
1. A copy of the current IRS determination letter indicating 501(c)(3) status

2. A copy of your W-9

3. Listing of Board of Directors

END OF YEAR REPORT
Each grant recipient is required to provide documentation of how the grant money was used. A narrative with pictures and receipts is required by December 1st of the year the grant was received. Please indicate below, using the checkboxes, that you understand and agree.
I agreeI do not agree
SIGN THE FOLLOWING STATEMENT
I hereby certify that the information contained in this application, including all attachments and supporting material, is true and correct to the best of my knowledge.
I confirm that by checking this box and typing my name below, I am electronically signing my application
Type Name

Title

I confirm that this application has been approved by the member of the board of directors named below.
Board of Director Name
Board of Director Title

NOTE: When you click the submit button to submit your application, a copy will be automatically emailed to you for your records.