2024 BFSRF GRANT APPLICATION
Please read through the application prior to review the information requested in order to complete it in its entirety. If a question does not apply to your organization, please indicate that with “NA". All applications must be submitted by September 6, 2024. Contact us with questions at bfsrf@westporty.org.
Organizational Information
The following information is specific to the organization for which you are seeking grant funding.
Legal Name of Organization
*
d/b/a Name
Federal EIN
*
Organization Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Organization Phone Number
*
Organization Website URL
*
Organization CEO/Executive Director
*
CEO/Executive Director's Email
*
example@example.com
Brief summary of your organization's history, mission and goals
*
Description of current programs, services and accomplishments of your organization
*
Demographics
Describe the target population your organization benefits
*
Ex. socio-economic status; language; age; physical abilities and/or other descriptions, as appropriate
Geographic areas served
*
Total number of population served annually
*
Percentage of minority population served %
*
Percentage of female population served %
*
Westport %
*
Indicate the annual percentage served from this region
Weston %
*
Indicate the annual percentage served from this region
Bridgeport %
*
Indicate the annual percentage served from this region
Fairfield %
*
Indicate the annual percentage served from this region
Norwalk %
*
Indicate the annual percentage from this region
Wilton %
*
Indicate the annual percentage served from this region
Other %
*
Indicate the annual percentage served from all other regions
Total number of employees
*
Total number of full-time employees
*
Total number of part-time employees
*
Percentage of minority employees %
*
Percentage of female employees %
*
Total number of volunteers
*
Total number of Board members
*
Percentage of minority Board members %
*
Percentage of female Board members%
*
Program Information
The following information is specific to the program for which you are seeking grant funding (the "Program"). The amount of grant funding you are seeking for the Program and to be spent in the calendar year is referred to as your "Grant Request".
Program Name/Title
*
Is this a new program?
*
Yes
No
Please provide a summary of the Program, including objectives, activities and timeframe
*
Statement of community needs/issues to be addressed by the Program
*
Describe target population and number of individuals expected to be served by the Program
*
Describe how the Program will benefit the community in a transformational way
*
Describe the Program goals for which funds are being requested
*
Describe how you plan to evaluate the success of the Program, including outcomes and how evaluation results will be used for program planning
*
List they key individuals involved in the Program; brief summaries including their titles and qualifications
*
Program Contact Name & Title
*
Program Contact's Email
*
example@example.com
Program Contact's Phone Number
*
Budget/Financial
Grant Amount Requested $
*
Period of time in which funds will be spent, beginning:
/
Month
/
Day
Year
Begin Date
Period of time in which funds will be spent, ending:
/
Month
/
Day
Year
End Date
Total Program Budget $
*
Please attach documentation detailing the budget for the Program, its income and expenses
*
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If we are only able to partially fund your grant request (e.g., if you received 50% of your grant request), will you be able to proceed with the Program?
*
List the funding sources for the Program (foundations, corporations, others) solicited for this request for the current year, and, if this is not a new program, for previous years (indicate the amounts requested and status of your proposal with each one)
*
Describe your long-term strategies for funding the Program beyond the grant
*
Current IRS 501(c)(3) Determination Letter
*
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Does your organization receive support from United Way, Combined Health, Arts Council or other federated funds?
*
Yes
No
Organization's Total Annual Budget
*
For fiscal year ending 2023
Organization's Total Annual Income
*
For fiscal year ending 2023
Organization's Total Annual Expenses
*
For fiscal year ending 2023
Please attach documentation detailing your organization's annual operating budget and actual income-and-expenses for most recently completed fiscal year
*
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Please attach documentation detailing your organization's annual operating budget and actual year-to-date income-and-expenses for the current year
*
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Please attach documentation detailing your organization's most recent annual financial statement (audited, if available) and management letter (if available)
*
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What internal financial/accounting controls does your organization follow?
*
Additional Information
Please attach documentation detailing any other relevant information to support your organization's request, ex. Cover Letter, Annual Report, Letters of Agreement, if this is a collaborative proposal, etc.
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Your Contact Information
Submitted By Name
*
First Name
Last Name
Submitted By Title
Submitted By Email
*
example@example.com
Submitted By Phone Number
Date of Application
/
Month
/
Day
Year
Date
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