Final Grant Application v2

Organization Information
Final Grant Application Number*
Organization's Legal Name*
About Your Organization
Organization History*
Organization Goals and Objectives*
Attach Additional Documentation If Needed

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Services offered by your Organization*
Attach Additional Documentation If Needed

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List Organizational Grant History (past 5 yrs: grantor, grant total, year, outcome)*
Attach Additional Documentation If Needed

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List income sources for your organization*
Attach Additional Documentation If Needed

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About Your People
Board of Directors/Trustees*
Board of Directors/Trustees
Attach Additional Documentation If Needed

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Key Personnel
Project Director
Bio
Chief Financial Officer
Bio
Total Number of Employees*
Total Number of Volunteers*

Project Information
Grant Information
Describe the charitable purpose of how the funds will be used.*
Attach Additional Documentation If Needed

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Is this a new project or an existing project?*

NewExisting
Are you seeking other sources of funding for this project?*

YesNo
If yes, please explain.
Attach Additional Documentation If Needed

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Applicant Biography:
Please include a list of your active projects
List collaborative partners. Briefly describe each partner and the value of this grant to each partner and disclose any conflicts of interest that you have with each collaborative partner.
Is an multi-year grant needed?*

YesNo
If yes, how many years?
If so, please explain.
Attach Additional Documentation If Needed

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Describe the timeline for implementation and completion of the project.*
Attach Additional Documentation If Needed

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What are the expected outcomes for this project?*
How will you measure and report the success of monies received*
Attach Additional Documentation If Needed

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Project Expenses

	Year 1	Year 2	Year 3	Cumulative
Salary and Fringe
Equipment (lease, purchase, maintenance)
Computer needs
Insurance
Marketing, public relations, advertising
Rent/occupancy
Supplies/materials
Other
Direct Cost
Indirect Cost
Total

Projected net income for other sources*
Indirect Costs (Fringe Benefits) % of total project cost*
Donations received based upon the most recent fiscal year-end*
% from corporations
% from foundations
% from individuals
If accepted, will you issue a Final Statement of Accounting for the grant?*

YesNo
Additional Information
Please attach additional letters of support or other explanations for consideration if you think this would help your case

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Please attach your current financial statement or most recent audit.

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Please attach annual report (if applicable)

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Please attached your most recent Form 990

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Acknowledgement
Name*
Title*
Signature*

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Date*

MonthDayYear
Date
Please verify that you are human*
Should be Empty: