GRANT APPLICATION EXAMPLE
Cover letter stating in first paragraph the amount of money requested and how the funds will be used
Copy of IRS Tax-Exempt Determination letter
Most recent IRS Form 990
Organization's Mission Statement
History of Organization
Current Annual Budget
Proposed Project Budget
List of other funding sources
Failure to provide these documents will result in a delay in approving your application.
Name of Organization Requesting Grant:
Address, City, Zip
Grant Writer’s Name:
Date Application Made:
Executive Director of Organization:
Check all that apply:
_____ 501(c)(3) Organization ____ Charitable Organization _____ Arts Organization
_____ Religious Institution _____ Other (State type): ____________________________________
Federal Tax Exempt Number of the Organization:
Amount Requested from Foundation:
In 2-3 words, tell us how the funds will be spent:
Geographic Area served by request:
Proposed Start Date for use of Requested Grant:
Approximate number of people served by your Organization: _________ (Break down by programs if necessary)
By signing this application, you agree to provide the foundation with a final report detailing how the funds you received were spent, how the project helped the people it was intended to help, receipts and photos.
By signing this application, you agree to repay any portion of the amount granted which is not used for the original purpose of this grant.
By signing this application, you agree to place all funds in a temporarily restricted account to be used for the purpose stated in your grant application.