Bethel Nonprofit Response Grant Round TWO

DEADLINE: March 26, 2021 at 5:00 PM

Make sure to review the program Guide for eligibility information:

Bethel Nonprofit Relief and Response Grants Guide

Section 1 (of 8) - Organization and Applicant Information

Nonprofit Name:*

Nonprofit Mailing Address*

PO Box or Mailing Address

CityState / Province

Postal / Zip Code

Nonprofit Phone Number*

Area CodePhone Number

EIN/Tax ID Number*

Contact Name:*

Contact Title/Position:*

Contact Phone Number:*

Contact Email Address:*

example@example.com

Section 2 (of 8) - Eligibility

This nonprofit provides services to residents of Bethel, and has been in operation and serving Bethel residents since at least January 1, 2019.*

YesNo

This nonprofit has a clear demonstrated physical, employee or service presence within the city of Bethel.*

YesNo

This organization is an IRS-certified 501 nonprofit - eligible types are listed in the Guide (fiscally sponsored projects are eligible to apply) .*

YesNo

Please list this nonprofit's 501 type [example: 501(c)3].*

If this nonprofit is a local affiliate of a national organization, does it have a local advisory or governing board?*

This nonprofit is not a local affiliate of a national organization.This nonprofit is a local affiliate of a national organization and has a local advisory board.This nonprofit is a local affiliate of a national organization and does not have a local advisory board.

A majority of this nonprofit's local board of directors or local advisory board and its officers are Alaska residents.*

YesNo

Section 3 (of 8) - COVID-19 Impact and Revenue Information

Was this nonprofit organization impacted by the COVID-19 public health emergency and is it in need of economic assistance?*

YesNo

What does your nonprofit need specifically related to COVID-19? (Focus on what additional activities, precautions, adaptations, solutions, collaborations, etc. your organization is implementing or plans to develop due to to the public health emergency. Describe what services would be lost to Bethel if this grant is not awarded. You may refer to the list on page 5 of the Nonprofit Response Round Two Grant Program Guide for grant priorities and pages 6 and 7 of the guide for more information on eligible expenses. Please complete the section below or provide a word document if preferred.)*

Maximum 1200 words, please.

Please identify the area(s) of funding for which you are applying, based on the Eligible Expenditure section, as described in the Nonprofit Response Round Two Grant Program Guide.*

MedicalPublic health expensesPayroll expensesExpenses of actions to facilitate complianceExpenses associated with the provision of economic supportOther expenses reasonably necessary

Section 4 (of 8) - Grant Request Information

Total Grant Requested:*

Maximum request is $50,000

Section 5 (of 8) - COVID-19 Revenue, Expenditures & Nonprofit Financial Information

Budget Spreadsheet (Please complete the budget spreadsheet or attach the excel spreadsheet that can be found online.)

	Project Budget Item	Bethel Nonprofit Response Request	Other Sources of Funding	Total Expenditure by 12/15/21
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
TOTAL

Sources of Other Funding

	Sources of Other Funding	Amount	Status of Funding
1
2
3

Budget Narrative (Your budget narrative should include a detailed description of how these funds would be spent per each line item in the submitted budget. Be sure to include details about other sources of funding if applicable and if the funding has been committed or secured. Please describe how your organization will ensure the funds are completely spent by December 15, 2021. You may provide your own budget narrative document if preferred.)

Did you organization file an IRS Form 990 for 2018 or 2019?

YesNo

Please attach your nonprofit's 2018 or 2019 IRS Form 990 [For nonprofits that do not file with the IRS, BCSF will accept an audited financial statement or an unaudited statement by a third-party preparer]*

Browse Files

Total Revenue as listed on Line 12 of your organization's most recent IRS Form 990:

If your organization did not file an IRS Form 990, please list the annual income found in your organization's most recent audited financial statement or an unaudited statement by a third-party preparer.

Operating Revenue for the last complete fiscal year:

Operating Expenses for the last completed fiscal year:

Please attach your nonprofit's Balance Sheet for the last completed fiscal year:

Browse Files

Please attach your nonprofit's current Operating Budget:

Browse Files

Please help us understand the local impacts of COVID-19. Does your organization need more financial assistance than it is eligible to receive from this range?

YesNo

If yes, how much additional funding would help your organization with COVID-19 impacts?

Below, please select all COVID-19 relief funding that you have applied for and/or received (or been approved to receive). Select "Not Applied For" if you have not.

BCSF Nonprofit Relief and Recovery Grant (noncompetitive)*

BCSF Nonprofit Response Round One Grant (competitive)*

AK CARES Grant*

Paycheck Protection Program*

Other Grants or Loans*

If you've applied for or received a BCSF Nonprofit Grant, AK Cares Grant, PPP, or other grant how much total money did you request/receive?

If you've received other relief funding, please explain how/why additional relief funding is needed:

This nonprofit will be able to fully expend funds by December 15, 2021.*

YesNo

Section 6 (of 8) - Application Instructions

This application is due by 5 p.m. March 26, 2021.

Need Help? Contact Lisa at covidnonprofit@bcsfoundation.org or call the BCSF office at 907-543-1812.

Applications may be amended before the deadline. Incomplete applications will be rejected. The grant funds received by a nonprofit organization must be fully expended by December 15, 2021. Checks not cashed within 90 days will be voided. An appeals process will be outlined in future correspondence.

Section 7 (of 8) - Questions

Questions about the grant program, application process or application status must be directed to Lisa Whalen at Bethel Community Services Foundation, by phone at 907-543-1812 or by email at covidnonprofit@bcsfoundation.org.

Section 8 (of 8) - Certifications and Signature

By signing this application, I certify, on behalf of myself and the nonprofit organization, the following under penalty of perjury:

1.That the information provided in this application is true and accurate to the best of my knowledge, information and belief.

2. My nonprofit organization has suffered economic hardship/impacts due to the COVID-19 pandemic.

3. I understand that if my organization receives a grant check, it must be cashed within 90 days or it will be voided.

4. I acknowledge that the funds will be spent by the required deadline of Dec. 15, 2021.

5. I agree to assist in the verification of information provided in this application and to provide additional information to BCSF, or its funders, auditors or contractors if requested.

6. That if my organization has received COVID-19 relief funds from other sources, it is still in need of additional relief funds from the Bethel Nonprofit Response Round Two Grant Program.

7. I acknowledge that the funds being provided are federal and and that it is the sole responsibility of the applicant to determine and to seek independent advice as to the tax and auditing implications to the applicant and its owners upon receipt and use of the funds.

8. I understand and agree that any Bethel Nonprofit Response Round Two Grant funds determined to have been used for a purpose not authorized by the CARES Act must be returned to BCSF and that I am liable for such funds. Additionally, any funds not expended by December 15, 2021 will be returned to BCSF by December 18, 2021.

9. I understand that BCSF may publish or publicly release a list of grant recipients, including the amount of individual grant awards. Information I submit to the BCSF as part of this application may be subject to inspection and release as part of auditing or public records requests (confidential information will be redacted).

10. The applicant shall maintain documentation following generally accepted accounting principles for how the funds are expended, including but not limited to financial records, payroll records or receipts. Grantee will provide documents to the BCSF if requested.

11. I agree to indemnify and hold harmless Bethel Community Services Foundation, its directors, officers and employees for any Bethel Nonprofit Response Round Two Grant funds the applicant receives from BCSF that the federal government, State of Alaska or City of Bethel determined were not used for eligible expenditures.

12. I certify that I have the authority to legally bind the applicant.

If all of the above outlined requirements are not met in full or if any information provided on the application is found to be false or incorrect, the applicant will be deemed immediately in default and all funds must be returned to BCSF within 30 days of written notification of default. I agree that, if the applicant accepts a Bethel Nonprofit Response Round Two Grant, the applicant is bound by the obligations and liabilities described in this application and that BCSF shall have the right to enforce these obligations and liabilities in any manner provided by law.

The undersigned represents, warrants and certifies that the information provided herein is true, correct and complete. I understand that this application, combined with award of a Bethel Nonprofit Response Round Two Grant, constitute a binding contract and shall be deemed a valid original instrument if delivered electronically (e.g. facsimile, PDF via email/online submission, stamp, etc.).

Electronic Signature*

By typing your name in this box, you certify that the content of this application is true and correct to the best of your knowledge.

Date:*

Date

Title

APPLICATION CHECKLIST

Completed Application (Includes budget spreadsheet and budget narrative)2018 or 2019 IRS Form 990 [For nonprofits that do not file with the IRS, BCSF will accept an audited financial statement or an unaudited statement by a third-party preparer]Balance Sheet- Last Completed Fiscal YearCurrent Operating Budget