REGULAR GRANT APPLICATION

GRANT APPLICATION

 

Please type or print your answers on this form and include it with your cover letter and additional information.

 

 

 

DATE:  _____________________________            AMOUNT REQUESTED:  _____________

 

 

Organization Name:  ____________________________________________________________

 

 

Date Established:  ______________________________________

 

Address:_________________________________City:____________________ State:  ______ Zip________

 

Contact Name:______________________________ Phone No.________________ Fax No: _____________

 

Annual budget of your organization:  __________________________

 

Number of employees last year:  ______________________________

 

Geographical area served by organization: ___________________________________________

 

Are you a United Way agency?         Yes      No

 

Are you a government agency?          Yes      No

 

Specify which of the following services you offer:

Arts/Humanities                     Environment

Children/Youth                       Recreation

Health & Medicine                 Elder Care

Education                                Social Welfare

 

 

List the members of your governing board:

 

 

 

 

 

 

  • Copy of tax determination letter from Internal Revenue Service showing name of organization, tax identification number, and type of tax-exempt organization: Attached Not available

 

  • Attach Annual Report for last year: Attached                     Not available

 

 

Limited to 501(c)(3) organizations located within the following counties:  Bibb, Fayette, Greene, Hale, Pickens, Lamar, Marengo, Sumter and Tuscaloosa. 


 

 

Need for the Project:

 

 

 

 

 

 

 

 

 

  Project Description:

 

 

 

 

 

 

 

 

 

  Project goals and anticipated outcomes:

 

 

 

 

 

 

 

 

  • Application submitted by: _______________________________________

Signature

 

_______________________________________

Print Name

 

_______________________________________

 

_______________________________________

 

_______________________________________

Address

 

_______________________________________

Phone

 

Application Deadlines are October 1 and April 1

 

Target Amount of Grant $1500.00

Grants for increased amounts will be given consideration