OSJ LOI Form

THE ORDER OF ST. JOHN OF JERUSALEM, KNIGHTS HOSPITALLER

UNDER ROYAL CHARTER AND CONSTITUTION OF His LATE MAJESTY KING PETER II

OSJ COMMANDERY OF FLORIDA

Pro Fide, Pro Utilitate Hominum

The Order's motto means "For Faith, For Service to Humanity." It serves as a member's moral compass and is upheld by all OSJ members while they strive to serve Christ's sick, poor, and the need worldwide to the best of their ability

To best serve potential grantees, the Order of St. John uses a two-stage grant application procedure: 1) Letter of Inquiry (LOI) and 2) Full Application. Following our review, if your LOI is accepted, you will receive our full grant application so that your request can be considered in more detail.

Please enter your responses directly in the form below. You may contact the Hospitaller with any questions or concerns at osjgrants@gmail.com.

Organization Details

Organization's Formal Name*

Organization name as it appears on your IRS Tax-Exemption Letter

EIN*

Organization's Common Name

Web site

Please provide details about your organization's principal location.

Street Address*

Unit Number

City*

State*

Zip Code*

Please provide your organization's mailing address if it differs from the address above.

Street Address or PO BOX

Unit Number

City

State

Zip Code

Please provide the following information about the head of the organization.

Name*

Title*

Phone*

Email*

example@example.com

Please provide the following information about the person who will serve as the point of contact if it is different from the head of the organization.

Name

Title

Phone

Email

example@example.com

Grant Request Details

All grant requests must relate to the overall charitable mission of the Order of St. John, which is the care of the sick and poor. Please select one category.*

Caring for the sickCaring for the poorFeeding the poorHumanitarian Intervention

Grant Amount Requested*

Your total budget for this program/project*

Project/Program Period Start*

Date

Project/Program Period End*

Date

Organization's total revenue in its most recent calendar or fiscal year or as shown on its most recent Form 990*

Source of revenue information

	Source	Year of Information
Calendar Year
Fiscal Year
Form 990

What is the geographic area served by the organization? Please list any demographic requirements that will be contained in your proposed grant.*

Target population to be served:*

Approximate total number of persons served each year:*

What percentage of those served will be men?*

What percentage of those served will be women?*

What percentage of those served will be youth?*

Please list major grants received within the most recent year.

	Amount ($)	Name of Funder	Purpose of Grant
Grant 1
Grant 2
Grant 3

Please list previous grants received from the Order of St. John of Jerusalem, Knights Hospitaller units, if any.

	Amount ($)	Year	Purpose of Grant
Grant 1
Grant 2
Grant 3

Please describe the principal purposes and services of the organization.*

Please summarize your organization's grant proposal request.*

Please attach: 1) Your IRS Federal Tax Exempt Status Letter, 2) A copy of your most recent State of Florida Annual Report, and 3) a copy of your last tax return, including all schedules.*

Submissions that do not include these attachments will be considered incomplete.

Please do not include brochures, videos, DVDs, books, news articles or any other promotional materials with your Letter of Intent submission.

If your Letter of Inquiry is accepted by the OSJ Commandery of Florida Hospitaller (Philanthropy) Committee, you will be recontacted by us with a full grant application package in order for us to obtain more complete and detailed information about your organization's proposed grant funding. You can expect to hear from us within 60 days of the date when we receive your completed Letter of Intent.

Letter of Inquiry Submitted by:

Signature*

Date*

Date

Printed name and title of the respondent*

Scott M. Coffey

Letter of Inquiry