Diocese of Allentown
Local Poverty Relief Fund Application
Full Name of Organization
What is the name of your project or program?
Organization Address Line 2
Organization Zip Code
Organization Leader's Email
Organization Phone Number
Type of Organization (Check One)
Diocese of Allentown Parish (or program therein)
Diocese of Allentown School (or program therein)
Affiliated Organization of the Diocese of Allentown (or program therein)
Other Nonprofit 501(c)3 organization
I certify that my Pastor has reviewed and approved this application
Affiliated Organization Name
Nonprofit Organization Name
Contact Person Phone Number
Contact Person Email
Please describe your funding request
What is the amount requested
Request should not exceed $10,000.
Is this a new grant request?
How many years have you received Local Poverty Relief Grant Funding
Please describe the needs of the local community below.
What steps did you take to determine the need for this project?
Is this a repeat funding request?
Please describe why your project should be funded again.
Please describe your organization's history and its leadership/administrative structure.
Briefly describe your organization’s fiscal policies & procedures. For example, record-keeping, internal controls, reporting, and oversight or audit.
Financial Profile: Beginning Balance
Last Year (Actual)
Next Year (Budget)
A: Beginning Balance
(Total of petty cash, checking, savings, & investments)
Financial Profile: Revenue
(net of fundraising expenses)
DOA LOCAL POVERTY RELIEF FUND GRANT
B: Total Revenues for the Year
Financial Profile: Expenses
Monetary assistance directly to recipients
(for example: cash, check gift cards...)
Monetary assistance on behalf of recipients
(for example: rent, utilities, medical...)
C: Total Expenses for the Year
Financial Profile: Total Revenues Less Total Expenses
D: Total Revenues Less Total Expenses
(B - C = D)
Financial Profile: Ending Balance
E: Ending Balance
(A + D = E)
Please list two outcomes for this proposal. Outcomes must be written in measurable terms. These goals will become the basis for evaluation of funded projects.
Please add any additional information or documentation you would like to provide to support this proposal.
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