MICF Grant Application Form

Grant applicants should follow the outline below. Only complete applications will be considered.

Name of group requesting the grant:

Contact Name

First NameLast Name

Contact Email

example@example.com

Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Requesting Group's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Names of officers, board of directors, etc.

Field of Operation:

i.e. cultural, social services, etc.

Amount Requested:

Name of project and description of needs or problems to be solved:

Describe concept/objectives of the project. How will this grant benefit the MI Community?

Describe duration of the project and number of people impacted.

List method of financing beyond the period of The MI Community Fund's support:

State whether aid is presently sought from other sources or whether such solicitation is contemplated. If so, from whom and how much? We encourage participation of others in funding your needs.

Budget Specification- Please provide a full accounting of your grant request below. Note: line item descriptions are suggestions only and you may deviate or disregard as needed.

Rows	Line Item Name/Description	Amount Allocated
PERSONNEL
ex. Program staff stipend
ex. Vendor Fees
ex. Technical support fee
TECHNICAL NEEDS
ex. Costumes
ex. Photographer
ex. Room Rental
ex. Equipment Rental
CONSUMABLE SUPPLIES
ex. Program specific supplies
ex. Promotional Material
ex. Postage
ex. Food & Beverages
TOTAL BUDGET (must equal grant amount requested)

Attach most current balance sheet of applying organization.

Attach copy of applicant's US Treasury (IRS) determination letter in order for MI Community Fund to insure we issue grants within the meaning and limitation of Section 501c(3) of the Internal Revenue Code of 1954, as amended.

Please enter any additional information you consider pertinent to your application.

Please list a past record of support by The Mercer Island Community Fund.

If you have any questions, please contact Brad Newcomer, MICF Grant Committee Chair.