NEW PASP Application

Partner Agency Scholarship Program (PASP) APPLICATION

Please complete the entire application. Review all sections before submitting your application, ensuring the accuracy and completeness of all information and ensuring all requested attachments are included. If a question does not apply, do not leave it blank. Instead, enter N/A.
The Spirit Club Foundation (the “Foundation”) was organized to assist people with disabilities by providing funding to promote health and well-being, including awarding scholarships for fitness classes, providing exercise equipment to residential service providers, and advocating on behalf of people with disabilities. Currently, the Foundation provides six month Partner Agency Scholarship Program (PASP) to organizations whose programs help enhance health and fitness opportunities for individuals with disabilities.

If your organization is interested in such support, then this application must be completed in full. Failure to fully complete the application will disqualify your organization from consideration.

Any organization who receives funding and wishes to obtain additional support must re-apply when the application period opens approx. two months prior to the expiration of the current PASP award period. The application for those organizations re-applying may be found on the Foundation’s website: www.spiritclubfoundation.org.
Project Title
Funding Amount Requested:
Total project budget, including all funding sources:
Applicant Summary:
Full Legal Organization Name
Organization DBA Name, If Any
Organization Website
Organization Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Organization Program or Executive Director

First NameLast Name
Title
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
E-Mail Address
example@example.com
Mailing Address
If awarded - address for PASP check to be recevied
Contact Person for this Program

First NameLast Name
Title
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
E-Mail Address
example@example.com

Organization Information
501(c)(3)?
Type of Entity (e.g. corporation; government, non-profit, LLC)
Year Established
Organization EIN (if applicable)
Attach a copy of your organization's official IRS notice of tax-exempt status (if applicable).

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ORGANIZATION OVERVIEW
Describe the mission of your organization:
Have you received financial support from the Foundation previously?
On what date and in what amount?
Describe the services or programs provided using the prior PASP:
PROJECT DESCRIPTION & BUDGET
Please provide a description of the project for which you intend to use the Partner Agency Scholarship Program funds and how the project aligns with the Foundation’s purposes.

Please include:
- the number of individuals you expect to serve
- the geographic area to be served
- the proposed timeline for the program
- the age range and disabilities represented within your project/program
- a basic proposed budget for the project.
- a sustainability plan for how you intend to continue providing these services after the initial six months
Project Description & Budget - please attach here:

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If your organization will be partnering with one or more organizations in using this Partner Agency Scholarship Program, please attach letters from each partner confirming their participation.
If applicable, please attach partnership letters here.

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RESULTS
What results do you expect to achieve during the award period? (examples can include improved health and fitness levels, increase social and emotional opportunities, etc)
Please describe how you will monitor and evaluate program effectiveness (examples can include participant surveys, health assessments, etc).
Type of Request
Geographic Area Served (county or counties)
Age range and disabilities of participants within the project/program:
Nationalities of people served on project/program:
*If possible provide us with gender ratio of participants:
Attach the current fiscal year operating budget, including income and expenses.

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Attach the annual budget for the previous fiscal year, including income and expenses.

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Attach the most recent Form 990, if applicable.

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If you are approved for a partner agency scholarship program, the Foundation will email your POC a contract to sign and send back agreeing to the terms of the partner program. Two months following the expected commencement date of your Organization’s project and again four months following the expected commencement date of your Organization's project, you will need to provide the Foundation with a written progress report indicating the results of the project to date. In addition, the Foundation may require your participation in an in-person or virtual meeting during the PASP award period to discuss your Organization's project being funded.
CERTIFICATION
By submitting this application, the individual with authority to bind the Organization, and the Organization’s Board of Directors or other governing body, hereby certify that they (1) have approved the submittal of this application, (2) all information is accurate and complete to the best of their knowledge, (3) the timing of the project as described will be met, and (4) the Organization is in compliance with all applicable state and federal laws and regulations to the best of their knowledge.
Signature:
Printed Name:
Title:
Date:
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Partner Agency Scholarship Program (PASP) APPLICATION

Applicant Summary:

Organization Information

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