First Name *

Last Name *

Title *

Organization *

Email *

Address Line 1 *

City *

State *

Enter required value

Postal Code *

Please describe the purpose of your organization? *

How long has your organization been in existence? *

IRS Determination Letter *

Please upload a copy of the applicant’s most recent determination letter from the Internal Revenue Service reflecting the applicant’s tax exemption under Section 501(c)3 of the Internal Revenue Code. If the name of the applicant is different from that shown in the Internal Revenue Service letter, the discrepancy must be satisfactorily explained, or satisfactory documentation must be provided to explain the applicant’s connection with the name on the tax exemption letter.

20MB max

Why is this request important to your organization? *

Organization's Directors or Trustees *

Please provide below the names and primary affiliations of the applicant’s current Directors or Trustees.

What percentage of the organization's funds is allocated to administrative costs? *

Amount of Funds Requested? *

Proposal/Project Narrative *

Please provide below a narrative proposal describing the applicant organization and the project for which funds are being sought, including a description of the persons or groups to be served. The narrative should include the number of people served during a one-year period.

What percentage of funds does the recipient actually receive? *

What percentage of your budget is funded by the FEDERAL GOVERNMENT? *

What percentage of your budget is funded by the STATE GOVERNMENT? *

What percentage of your budget is funded by the COUNTY GOVERNMENT? *

What percentage of your budget is funded by CITY GOVERNMENT? *

What percentage of your budget is funded by the CORPORATIONS? *

What percentage of your budget is funded by the ENDOWMENTS? *

What percentage of your budget is funded by the FOUNDATIONS? *

What percentage of your budget is funded by the PRIVATE DONATIONS? *

What percentage of your budget is funded by the UNITED WAY? *

What percentage of your budget is funded by the OTHERS NOT REFERENCED ABOVE (please explain)? *

In what geographic area will the grant funds be allocated? *

In this part of a matching fund program? If yes, please explain. *

List of Other Contributors *

Please provide a list of the other contributors to date for the project and the amounts received from each. If none, please so indicate. (If none, please so indicate.)

List of Other Sources *

Please provide a list of the other sources being approached for the project and the amounts requested from each. (If none, please so indicate.)

Detailed Budget *

Please uploaded a document that provides a detailed budget for the proposed project, the grant amount sought from the Foundation, and the date the funds will be needed.

20MB max