Y-12 FCU Gives Foundation Grant Request

Grant Request Application

Y-12 FCU Gives Foundation
Organization Information
Organization Name*
Date*

MonthDayYear
EIN/Tax ID#
Organization URL
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Name*

First NameLast Name
Contact Title
Contact Email*
example@example.com
Contact Phone Number*

Area CodePhone Number
Grant Request Information
Dollar Amount Requested*
Purpose of Grant*
Please describe how your request supports our mission to enhance and support educational initiatives, improve health andwellness and create awareness, or be a first responder to emerging community needs; specifically related to our focus areasnoted in the guidelines: *
Anticipated number of participants or individuals that will benefit from the service*
Has the organization received support from Y-12 Federal Credit Union or Y-12 FCU Gives Foundation?*

YesNo
If Yes, please tell us when you received support and how much you received*
Does the organization have a relationship with Y-12 Federal Credit Union or Y-12 FCU Gives Foundation?*

YesNo
Please describe other sources of funds for this program/project: *
Please list the top three measurable results you expect to accomplish if this grant is awarded?*
Are there other ways we can assist in lieu of or, in addition to, the requested financial assistance? *
Does this request include any promotional opportunities or recognition for Y-12 FCU Gives?*

YesNo
If yes, please describe:*
How did you learn about the Y-12 FCU Gives Foundation?
For a grant request of $5,000 or greater you will need to submit the following documents with your application:
- Most recent annual report for the organization
- Total board approved annual operating budget for the current fiscal year and a complete project budget, if applicable
- Current Board of Directors list with background and affiliation of each member;
- Most recent, current independent financial audit. (Copy of 990)
  YTD financial statement (income and expense) for your current fiscal year
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Organization Information

Grant Request Information