Grant Funding Application Form

Grant Funding Application Form

All information provided below will be kept confidential. Please complete all required fields marked with an asterisk (*).
ORGANIZATION INFORMATION
Name of Organization applying:
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone number for organization:
Please enter a valid phone number.Format: (000) 000-0000.
Executive Director/CEO/President:
Organization Website:
Annual Budget of the organization:
Total number of full/part time staff:
Number of Years in Operation:
Organizational Mission:
Area of Service:
Does the organization have a Strategic plan:
Are you part of any national/regional/etc. Organization? If yes, please provide name of Organization:
Do you currently partner with other organizations and if so please list:
Are you affiliated with any Christian organization or is any part of your program placed in Christian principles and if so please elaborate:
PROGRAM INFORMATION
Name of program(s) seeking funding:
Program director:
Target population of program: (infants/toddlers, school age children, elderly,etc.)
Briefly describe the programming provided:
What are the anticipated outcomes of the program:
Number of individuals (unduplicated ) served in past year:
Number of units of service provided in the past year:
Please share any success stories:
Specifically, how will grant funds received be used:
Has the program been funded by other sources in the past and if so please elaborate:
Please provide annual budget of program. Are matching funds available or being used?:
ADDITIONAL INFORMATION NEEDED
Instruction: Please email a copy of the following to madelynne@sspres.org

1. A copy of your IRS 501(c)(3) determination letter
2. A roster of your board of directors
3. Meeting schedule of board of directors
4. A copy of your current profit and loss statement
5. A copy of your current budget
6. A copy of your most current IRS Form 990
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Grant Funding Application Form

ORGANIZATION INFORMATION

PROGRAM INFORMATION

ADDITIONAL INFORMATION NEEDED