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*
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*
Itemized Project Budget*

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

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

Cancelof
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*

Cancelof
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