Diocese of Allentown
Local Poverty Relief Fund Application
Organization
*
Full Name of Organization
What is the name of your project or program?
*
Project/program Name
Organization Address
Organization Address
Organization Address Line 2
Organization City
Organization State
Organization Zip Code
Website
Organization Website
Organization Leader
First Name
Last Name
Email
Organization Leader's Email
Organization Phone Number
-
Area Code
Phone Number
Type of Organization (Check One)
*
Diocese of Allentown Parish (or program therein)
Diocese of Allentown School (or program therein)
Affiliated Organization of the Diocese of Allentown (or program therein)
Other Nonprofit 501(c)3 organization
Parish Name
Pastor Name
I certify that my Pastor has reviewed and approved this application
YES
NO
Pending
School Name
Affiliated Organization Name
Nonprofit Organization Name
Contact Person
*
First Name
Last Name
Contact Person Phone Number
*
-
Area Code
Phone Number
Contact Person Email
*
example@example.com
Please describe your funding request
*
What is the amount requested
*
Request should not exceed $10,000.
Is this a new grant request?
Yes
No
How many years have you received Local Poverty Relief Grant Funding
Please describe the needs of the local community below.
What steps did you take to determine the need for this project?
Is this a repeat funding request?
Yes
No
Please describe why your project should be funded again.
Please describe your organization's history and its leadership/administrative structure.
Briefly describe your organization’s fiscal policies & procedures. For example, record-keeping, internal controls, reporting, and oversight or audit.
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Financial Profile: Beginning Balance
Rows
Last Year (Actual)
Next Year (Budget)
Beginning Balance
(Total of petty cash, checking, savings, & investments)
Financial Profile: Program Revenue
Rows
Last Year
(Actual)
Next Year
(Budget)
A. Fundraising & Donations
B. Diocese of Allentown Local Poverty Relief Grant
C. Other Grants (Public, Private, and/or Foundation)
D. Other Income
Total Revenue (Please ADD A thru D)
Financial Profile: Expenses
Rows
Last Year
(Actual)
Next Year
(Budget)
E. Personnel/Salary Expenses
F. Other Admin Expenses
G. Program Expenses
H: Other Expenses
Total Expenses (Please ADD E thru H)
Financial Profile: Annual Profit/Loss
Rows
Last Year
(Actual)
Next Year
(Budget)
Annual Profit/Loss (Total Revenues MINUS Total Expenses)
Financial Profile: Ending Balance
Rows
Last Year
(Actual)
Next Year
(Budget)
G: Ending Balance (Please ADD Beginning Balance and Annual Profit/Loss)
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Project Goals
Please list two outcomes for this proposal. Outcomes must be written in measurable terms. These goals will become the basis for evaluation of funded projects.
Outcome 1:
Outcome 2:
Please add any additional information or documentation you would like to provide to support this proposal.
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Should be Empty: