Final Grant Application Number
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Organization's Legal Name
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1. About Your Organization
a. Organization History
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b. Goals and objectives
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c. Services
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d. What is your grant history? (past 5 years: grantor, grant total, year, outcome)
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e. What are the income sources for your organization?
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Are there collaborative partners?
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Yes
No
f. If so, briefly describe each partner and the value of this grant to each partner and disclose any conflicts of interest that you have with each collaborative partner.
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2. About Your People
a. List your Board of Directors/Trustees
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i. Include name, title, business, address, phone, e-mail, website and role on board (if applicable)
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b. Other key project personnel, including project director and Chief Financial Officer (CFO)
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i. Include contact information and short paragraph on key personnel roles (if applicable)
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c. Total number of employees and total number of volunteers:
Employees
Volunteers
2. Grant Information
a. Describe the charitable purpose of how the funds will be used.
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b. Is this a new project or an existing project?
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New
Existing
c. Are you seeking other sources of funding for this project?
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Yes
No
If yes, please explain.
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d. Is an multi-year grant needed?
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Yes
No
If so, please explain.
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e. Describe the timeline for implementation and completion of the project.
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f. What are the expected outcomes?
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g. What are the project expenses?
i. Charitable purpose
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ii. Staff
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iii. Equipment (lease, purchase, maintenance)
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iv. Computer needs
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v. Insurance
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vi. Marketing, public relations, advertising
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vii. Postage/Delivery
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viii. Rent/Occupancy
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ix. Supplies/Materials
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x. Miscellaneous (line item)
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h. Projected net income for other sources
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i. Donations received based upon the most recent fiscal year-end
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i. % from corporations
ii. % from foundations
iii. % from individuals
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j. How will you measure and report the success of monies received?
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k. If accepted, will you issue a Final Statement of Accounting for the grant?
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Yes
No
4. Additional Information
a. Please include additional letters of support or other explanations for consideration if you think this would help your case
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b. Current financial statement or most recent audit; including most recent IRS Form 990.
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c. Annual report (if applicable)
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5. Acknowledgement
Signature
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Date
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 -
Month
 -
Day
Year
Date
Please verify that you are human
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