Grant Application Form - Kjellstrom Family Foundation

The Kjellstrom Family Foundation Grant Application

Applicants are encouraged to save application information to be submitted. Completed applications will not have a print option. Please also be aware that the application, once opened, cannot be saved and edited at a later date. Please be thorough yet concise in describing the program/project to be funded, including all collaborating partners and their role in your program/project. Please also add to the list of financial information desired "a one-page grant program/project budget.

The application must be submitted by 5 p.m. on the deadline date.

Organization Name: *

Address: *

City: *

Zip: *

Contact Person: *

Phone Number: *

Fax Number:

Email Address: *

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Organization Mission

Summarize the organization's mission: *

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Funding Request

Describe the program, project, grant match or endowment challenge for which funds are currently sought and the grant amount sought: *

What is the total goal of this fundraising activity? *

Amount of Grant Request: *

Please attach to this application the project budget for the funds being requested:
(Accepted file types: pdf, doc, docx, xls, xlsx, or txt)

Project Budget (include ONLY the revenue and expenses specific to the proposal): *

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Narrative (Explain each line and how you calculated the total): *

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Sustainability/Reaching the Goal

If the grant does not provide full funding for the program, project or grant match, please describe how the goal will be reached: *

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Internal Organizational Commitment

What percentage of board members made a financial contribution the past fiscal year? *

What percentage of board members are active in fundraising? *

On an annual basis, how many volunteers, excluding board members, are active in your organization? *

Please attach to this application the names of:
(Accepted file types: pdf, doc, docx, xls, xlsx, or txt)

The current chief executive: *

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The current board of directors: *

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Financial

Please attach to this application:
(Accepted file types: pdf, doc, docx, xls, xlsx, or txt)

A copy of the organization’s most recent audited financial statement:

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A copy of the organization’s Form 990 or 990-EZ (ONLY if no audit):

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A copy of the organization’s Federal IRS 501(c)(3) exemption letter: *

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A copy of the organization’s current year operating budget *

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If you wish to provide additional support documentation for this request (i.e. brochures, pictures, etc.), please upload additional documents here.

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I am interested in collaborating with another nonprofit partner

Explain:

The Trustees of the Kjellstrom Family Foundation are interested in connecting organizations to one another to enhance programs and services. By checking this box, we will connect you with other nonprofits organizations doing similar or complementary work so you can initiate discussions around programmatic or organizational collaboration.

Application Due Dates:

April 15

August 15

November 15

If you have any questions contact:

Pam Clark Reidenbach, Lead Trustee
8500 E. State Street
Rockford, IL 61108
815-753-8733 or call 815-494-6815

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