Northeastern Potter Economic Support Fund Grant Application

Knoxville Fund

Grant Application
The Knoxville Fund was established in 2017 to provide support of the charitable, scientific, or educational purposes to non-profit organizations including 501(c)(3) agencies who serve the citizens of the Borough of Knoxville, Tioga County, Pennsylvania.
Organization Name*
Tax ID Number (EIN)*
Which best describes your organization?*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name*

First NameLast Name
Position/Title*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Website URL
Year Established
Mission Statement*
What programs and services do you currently offer Knoxville Borough citizens?*
In the past 12 months, how many individuals from Knoxville Borough have directly benefited from your services?*

Project Budget*

	A CFTT Grant Request	B Funds From All Other Sources	A + B Total Project Cost
Salaries
Equipment
Rent/Mortgage
Utilities
Transportation
Other
Total

If "Other" is used in the table, please describe
Please ensure that column B Funds From All Other Sources includes revenue from other grants/contracts including state, local, or federal governement, other foundations, corporations, and individuals. Also included earned income from other sources such as events, membership income, in-kind support, etc.
Please share any partnerships/relationships that will be needed to support grant activities.
Where else are you applying for funding?

Describe the Need: Briefly outline the problem or need your project will address. Include any data or evidence supporting this need.*
Target Population: How will the citizens of Knoxville Borough directly benefit from this project? Approximately how many people will this represent?*
Goals and Outcomes: What are the desired results or outcomes of this project? What specific products or services will be delivered?*
Activities and Timeline: What actions or activities will take place to achieve the project goals? Provide a brief timeline for these activities.*
Measuring Success: How will you measure the success of your project? What evidence will demonstrate the project’s positive impact or benefits for Knoxville Borough citizens?*
Sustainability: If applicable, how will the project continue after CFTT funding has ended?

Optional: Add any additional information you feel is important to share.
Attach any documents that may help determine eligibility. If capital request, two estimates are required.

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I understand that if selected for a grant, a final report will be due to CFTT one year from the grant award date highlighting the outcomes and successes. 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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Knoxville Fund