The Rico Center Grant Application

Please verify that you organization qualifies before proceeding.

ü Conducts activities and programs consistent with the Rico Center’s mission and purpose.

ü Serves the people living or working within the Rico Fire Protection District area.

ü Qualifies as a 501(c)(3) tax-exempt entity under the IRS, a local government agency or
subsidiaries, or will have an arrangement with a qualifying fiscal agent.

ü An acceptable business plan demonstrating fiscal responsibility, long-term viability,
and a well-researched business plan
If your organization wishes to apply for multiple grants and/or grant projects you will be required to submit a grant application for each. Grant requests for multiple projects on one application may be denied.
You can save a draft of this form and come back to complete it later. Click "SAVE" at the bottom of any page and make sure to enter a valid email address, a link to return to your draft will be emailed to you. We encourage frequent saving to avoid losing your work.

Impact & Long-term Vision
Describe the target population of the community that the grant project aims to impact*
If applicable, describe the long-term funding sources & strategies for this grant project
What tools and metrics will be used to measure the success of the grant project?*

Budget and Financials
Please provide the Rico Center with the following

information about your organaztion.

ü Current Financials: Statement of Activities, Statement of Financial Postion (audited if available).

ü A full budget for the period

ü A grant project budget

ü Copy of the Internal Revenue Service 501(c)(3) tax exempt determination letter, or a fiscal agent agreement (if applicable)

ü Any additional supporting documentation (quotes, bids, itemized breakdown of project expenses)
All files below are limited to one file per submission and must be in pdf format. Multiple page documents will be accepted as long as they are combined in the same file.
Statement of Activities (Profit & Loss) *

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Statement of Financial Position (Balance Sheet)*

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Full Organization Budget*

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Grant Project Budget*

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IRS 501(c)(3) Tax Exempt Determination Letter*

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You may upload as many documents as you need for the additional supporting documentation section. Photos and other formats will be accepted.
Optional: Additional supporting documentation (photos, examples, itemized breakdown of project expenses).

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Agree & Sign
In submitting this application, you hereby agree that all information provided is accurate to the best of your knowledge. As the applicant, it is agreed that if funds are granted, funds will be used soley for the purposes stated in this application. Upon acceptance of any awards, you agree to abide by any terms and/or conditions that the Rico Center imposes.
Signature*

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Name*

First NameLast Name
Date*

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Date
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