Russell Hill Rogers - Grant Application

Application
Name Doing Business As
Legal Name (as on determination letter)
Tax ID#
Name of organization’s Executive Director or Head of Administration
Organization Name (to whom the check should be made out to)
If grant is awarded
Title/Position
Contact Phone Number
Format: (000) 000-0000.
Contact Phone Extension
Contact Email
example@example.com
Mailing Address (Where the Check Will be Mailed)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County/Counties where services are provided
Project Information
Project Name
Expected Audience Numbers
Proposed Event Date(s)
Project Venue
Amount of funding requested
Project Description - Please describe your project in a paragraph below.
Other current and potential sources of funding for the project
Source
Amount Requested
Amount Received to Date
A list of the current Board of Directors and their affiliations
How will the RHRFA name be recognized?
Organization Operating Expense
Total Annual Operating Expense
Total Payroll Expense
Number of Paid Employees
Organization Revenues
Total Annual Revenues
Top Five Revenue Sources
Top Five Revenue Sources

List the amount and a description for each source
Source 1
Source 2
Source 3
Source 4
Source 5
Itemized Project Budget

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Copy of the organization's IRS Tax-Exempt Determination Letter

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Most recent financial statement and income-and-expense budget for the organization

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ONLY Parts I, II and III of the most recent Form 990 submitted to the IRS; the 990 in its entirety is no longer required

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All applicants will receive an email confirmation of receipt once the application has been successfully submitted. Please verify that this email confirmation is received after submission and retain it for your records.
Should be Empty:

Application

Project Information

Other current and potential sources of funding for the project

Organization Operating Expense

Organization Revenues

Top Five Revenue Sources