Northeastern Potter Economic Support Fund Grant Application

Northeastern Potter Economic Support Fund

Grant Application
The Northeastern Potter Economic Development Assocation (NEPEDA) partnered with the Community Foundation for the Twin Tiers (CFTT) to provide an economic development grant program that will provide support to non-profit organizations including 501c(3) agencies or charitable grant programs in the north eastern area of Potter County. This includes the areas of townships and boroughs served by the Norther Potter School District: Ulysses Township, Ulysses Borough, Harrison Township, Genesee Township, Allegheny Township, Bingham Township, and Hector Township.
Organization Name*
Tax ID Number (EIN)*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name*

First NameLast Name
Title/Position*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Website URL
Year Established
Mission Statement*
Service Area (select all that apply)*
Organization Mission (select one)*

Project Budget*

Column A Grant Request is the breakdown of the this grant being requested. The total should equal the amount of grant request.

Column B Funds From Other Sources includes revenue from other grants/contracts, earned income from events, membership income, in kind support, etc.

Is there any additional information you would like to share?
Please attach any documents that may help determine eligability (optional)

Although optional when applying, additional documents could be requested to determine eligability such as IRS Classification Letter, Organization Operating Budget, List of Board of Directors.
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I understand that if selected for a grant, a final report may be requested by CFTT one year from the grant award date highlighting the outcomes and successes. If requested, the Organization will not be eligible to apply for additional grants until project and final report form are complete.
Signature*

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If you have any questions about this application, please contact (570) 888-4759 or email info@twintierscf.org
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