Organization Name

• Address
• City
• State
• Zip Code
• Contact Person
• Phone Number
• Email

Organization Mission

• Summarize

Funding Request

• Describe the program, project, grant match or endowment challenge for which funds are currently sought.
• Total financial goal of this project/activity
• Amount of grant request
• Project Budget Upload
• Narrative (Explain each line and how you calculated the total)

Sustainability

• If the grant does not provide full funding for the program/project/match, please describe how the goal will be reached.

Internal Organizational Commitment

• What percent of board members made a financial contribution this past fiscal year?
• What percent of board members are active in fundraising?
• On an annual basis, how many volunteers, excluding board members, are active in your organization?

Supplemental Information

• Name of Chief Executive
• Current list of Board of Directors

Financials to be attached

• Copy of organization’s most recent audited financial statement
• Copy of organization’s Form 990 or 990-EZ (only if no audit)
• Copy of organization’s federal IRS 501(c)(3) exemption letter
• Copy of organization’s current year operating budget

Additional

• Interested in collaborating with another nonprofit partner
• Explain