Please complete this form in its entirety. Someone will respond to you shortly afterwards for nexts steps in our grant process.
Eligible projects impact single-mothers, children, and the elderly. We also only grant up to $1000 per project, per grantee, per year.
Standard receipt dates for new grant applications are January 1 - March; and July 1 - September 1. all fields are required except fax A. ORGANIZATION AND PROGRAM/PROJECT INFORMATION 1. Legal organization name: 2. Year organization was founded: 3. Tax status: Tax ID # (EIN): 501 (c)(3) nonprofit status yesno
4. Organization address: 5. Telephone: 6. Fax: 7. Organization website: 8. Executive Director or principal officer (Name and Title): 9. Email: 10. Contact for this proposal: 11. Daytime telephone: 12. Email: 13. Mailing address, if different from above: 14. Amount requested: : 15. Period grant will cover: 16. Type of request (check all that apply): General SupportProgram/project supportCapital ProjectOrganizational DevelopmentOther
17. Program/Project Title: 18. Total Project Budget: 19. Total organizational budget (current year): 20. Summary of the organization’s mission (two to three sentences): 21. Summary of the project or grant request (two to three sentences): 22. Who will be served by the project or grant {demographics, direct number served and service area(s)}? 23. What is the minimum and maximum number of Board members required by your organization’s Bylaws? 24. How much money did the Board of Directors (your organization’s governing board) contribute to the organization in the most recent fiscal year? 25. What percentage of the Board of Directors donated funds; and how much?
The organization hereby agrees that everything above is factual and can be proven with supporting documentation. Signature of authorized representative (type name below)
The organization hereby agrees that funds, if granted, will be used only for the purpose described above unless written approval from the grantmaker is received. Signature of authorized representative (type name below) What is 44+2 Please leave this field empty.
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