GRANT APPLICATION EXAMPLE

 

Required Attachments:

  • 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.

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Name of Organization Requesting Grant:

Address, City, Zip

Web Address: 

Email Address: 

Contact Number(s): 

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.

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