Willis Foundation Mini Application

Phil and Pat Willis Foundation

Grant Application
Contact Information
Date of Application*

MonthDayYear
Tax ID*
Legal Name of Applying Organization:*
Should be the same as on IRS Form 990 or Letter of Determination supplied as part of this application.
Year Founded:*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Organization Website:*
Executive Director/Organization President:*

First NameLast Name
Title:*
Phone Number:*

Area CodePhone Number
Email:*
example@example.com
Contact Person (if different):

First NameLast Name
Title:
Phone Number:

Area CodePhone Number
Email:
example@example.com
Proposal Request
Project Name:*
Purpose of Grant:*
Amount Requested: *
Total Project Cost: *
Will you accept partial funding?

YesNo
Is your organization a 501(c)3?

YesNo
Geographic Area Served:*
Time Frame for Project*
Budget Format

Below is a listing of standard budget items. Please provide the project budget in this format and order.
A. Organization's fiscal year*
B. Time period this budget covers: *
C. Expenses: Include the total amount for each of the categories in the table below. Include a budget narrative on a seperate page that describes how the total amounts were calculated and provide supporting documents, i.e., bids, invoices, etc.

	Amount Requested	Total Project Expenses
Salaries:
Payroll Taxes:
Fringe Benefits:
Consultants/Professional Fees:
Insurance:
Travel:
Equipment:
Marketing:
Occupancy Cost (rent, utilities, Maintenance)
Office Expense (supplies, copier, phone, postage)
Capital Improvement Budget

If other, please specify here:
Total Requested:
Total Expenses:
D. Revenue: Include the total amount for each of the budget categories listed. Please indicate which sources of revenue are committed and whihch are pending.

If other, please specify here:
Total Committed:
Total Pending:
*Note: The total revenue from committed sources and pending sources must be equal to the projected budget for your project.
Electronic Signatures

The typed in names below represent your handwritten signature.
Chairperson, Board of Directors: *
Date*

MonthDayYear
Date
Executive Director:*
Date*

MonthDayYear
Date
Additional Items Required
Please upload each of the following to this application:
1. Summary: In 500 words or less describe your request and purpose for funding. Include how the award would be a benefit to your organization and to the Jackson community. Please include any collaboration with other organizations.
2. Current Contact List of Board of Directors and Staff.
3. Current year's annual budget and comparison to actual if applicable.
4. Most recent annual audited or reviewed financial statements or form 990k.
5. Letter of 501(c) 3 designation.
6. Details of capital improvement project
Browse Files

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Note: Incomplete applications will not be accepted.
Should be Empty:

Phil and Pat Willis Foundation