Grant Writing Request

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* Grant Writing Request *
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Contact Information
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Full Legal Organization Name
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Street Address
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City
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State
Please Select
Please Select
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
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Zip Code
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Organization Website
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Organization President / Executive Director
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Your Title
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Your Phone Number
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Your E-Mail Address
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* Grant Writing Request *
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Organization Information
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501(c)(3)?
Yes
No
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Year Established
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Fiscal sponsor nameIf applicable
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Fiscal sponsor addressIf applicable
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Total Organization Budget
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Total # of Board Members
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Total # of Staff
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Total # of Volunteers
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Organizational Mission Statements
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Brief Description of Organization
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Population Served
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Grant Writing Request
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Proposal Request
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Program / Project Name
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Total Program Budget
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Requested Amount
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Type of Request
Please Select
Please Select
Capacity Building
Capital Campaign
General Operating
Multi-Year Project
Program Support
Start Up
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Grant Period From
Date
Month
Day
Year
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Grant Period To
Date
Month
Day
Year
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How does your organization currently get most of its financial support?ex: grants 40% of your operating budget, 25% individuals, 5% churches, 15% special events, 10% corporations, 5% investments.
Huge
Large
Normal
Small
Ok
Ok
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List actual grants you have received & not received for the last year.Provide grant name, agency and amount awarded
Huge
Large
Normal
Small
Ok
Ok
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List the 3 nonprofit organizations that provide similar programs/services to your organization.Provide grant name, agency and amount awarded
Huge
Large
Normal
Small
Ok
Ok
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Multi-Year?
Yes
No
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Geographic Area Served
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Priority funding areas
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Most recent grants received:
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Grant Award 1Grant name, grantor, amount & date
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Grant Award 2Grant name, grantor, amount & date
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Grant Award 3Grant name, grantor, amount & date
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Grant Award 4Grant name, grantor, amount & date
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What else would you like to share about your request?
Huge
Large
Normal
Small
Ok
Ok
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Appointment Availability
Should be Empty: