Grant Application Form

Grant Application Form

Foundation of Cornerstone Communities
Organization Name
EIN
Fiscal Responsibility: Is this organization a

city or county church school 501.c3 none
If none is selected, you will need to partner with a fiscal sponsor for this application. The Fiscal Sponsor Agreement is located on our website.
Contact Person
Email
example@example.com
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
What is the purpose or mission of your organization:
What year was your organization founded:
Describe how your organization is staffed (paid or volunteer)
Project Title followed by 1 - 3 sentence project description:
Total project cost:
Amount you are requesting for the project:
How will the project impact the long-term (10 years) and short-term (1 year) health and vitality of the residents in the region:
How many residents will the project directly impact in a continuous way:
Which communities within the Guttenberg Municipal Hospital & Clinics service area does this project serve:
In what ways will you promote the Foundation of Cornerstone Communities if you are awarded funding:

FCC cling signage ribbon cutting or project completion celebration local news release social media
Attachments
1. Project Budget (Reminder to include a column for cash match, pending grants, and volunteer hours x $15)
2. Current Budget for organization
3. Board of Directors
4. Fiscal Sponsorship Agreement (if needed)
5. IRS Tax Determination letter if applicant or fiscal sponsor is a 501.c3
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Grant Application Form

Attachments