Grant Application
Please see Grant Guidelines for further information.
Application Deadline: August 31, 2021
Date
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Month
-
Day
Year
Date
Name of Organization
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Project Title
*
Contact Person
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First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Contact Phone Number
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Please enter a valid phone number.
Secondary Contact Phone Number:
Phone Number
*
Fax Number:
Phone Number
*
Email
*
example@example.com
Organization Web Address
*
Amount Requested
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Grant Amount Requests may not exceed $10,000.00
Date funds are needed by?
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Please upload a copy of your organization's latest audited financial statement and a letter from the IRS stating your exemption status:
*
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How were you informed of RMHC of NEPA?
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Have you received a RMHC of Northeastern Pennsylvania grant in the past?
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Please Select
Yes
No
If so, please state the date and the amount rewarded:
If you have received a grant in the past, have you submitted your Grant Closeout Report? This is required in order to request funding again. Please submit your report in order to meet the qualifications below:
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History
Please provide us with a brief history of your organization, including the overall goals and purpose of your organization and a specific description of the needs or problems addressed.
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Target Population
Please summarize your target population in measurable terms (i.e. who the primary audience, how many will be served, how old are the participants, where the program can be offered, and the geographical range of the program or project for which there request is being made.) For example, your program helps 125 disabled children, ages 6-12 in Williamsport; or 1,000 high school seniors in Wilkes Barre, etc. al.
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Summary
Please provide concise information on the program and how it will work, the specific purpose of the use of funds, and how your objectives will be accomplished. What is unique or innovative about your program?
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Budget
Amount requested from Ronald McDonald House Charities of NEPA:
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Please upload an itemized budget for both the requested project and for your organization. (Detail your current sources of income and the expenses, and include a balance sheet from the past year. Proved plans for contributions from other institutions or organizations, if any, and your most recent funding report):
*
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Evaluation
How will you determine the impact of this project? For example, through a survey of parents and children, an appraisal of physical improvements, attendance figures, etc. Please be specific. If the project is funded, a grant status report will be required 30 days after completion and/or one year after the grant is awarded. If you received grant funding from the Ronald McDonald House Charities of NEPA in the past, it is mandatory that the Grant Closeout Report be turned in before a new application can be considered.
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Grant Application Check List
Check List Questions:
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Is the complete application packet submitted?
Is the cover letter on your organization's letterhead?
Is it signed by a senior management official of the organization?
Does my grant fall within the required guidelines of RMHC of NEPA?
Did you include the following items?
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The Project Budget
The Organization Budget - Statement of Income & Expenses
The Organization Budget - Balance Sheet
The Organization Budget - Income support and revenue sheet
The Organization's most recent audited financial statement
A copy of the Organization's current 501c3 form
Submit
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