APPLICATION FOR A SMALL GRANT
Organization Name *
Tax/EIN Number *
Address *
Fiscal Sponsor
If your organization is using a fiscal sponsor, please attach a letter of support from the fiscal sponsor, their IRS determination letter and complete the following.
Organization Name
Contact Name
Contact Phone
Email Address
Tax/EIN Number
Address
Letter of Support
IRS Determination Letter
Grant Request Amount *
Total Match *
Project Title *
Project Summary *
Grant Project Leader Contact Information
The person responsible for carrying out proposed project and submitting the final report.
Name *
Email *
Work Phone *
Cell Phone *
Current Position *
Number of years in current position *
Prior Experience *
Organization Contact Information
Name of Organization’s CEO/Director/Principle *
Position *
Organizations Annual Operating Budget (except schools) *
Organization Description *
Partner Organization #1 (required)
Name of Organization *
Contact Person *
Phone *
Describe the partner’s role in implementing the project *
Project Description (Please describe your project succinctly)
Expanded Project Description (include need and rationale) *
Educational Benefits *
Environmental Benefits *
How will this project engage children in learning? *
Faculty/Staff Involvement- Please add each members’ Position, Role, and Organization *
Project Impact- Please list Grade/Age and the Number of Students *
Total Number of Students, all ages and grades: *
Cost per Student *
Number of additional students who will indirectly benefit from the project *
Percentage of children who receive free or reduced lunch *
Potential Project Challenges or obstacles *
Project Sustainability *
Project’s Eco-Friendly Practices *
Project Evaluation *
Project Timeline
Project Start Date *
Project End Date *
Project Budget- For each item please include the Quantity, Item Description, Unit Cost, Funds from CF, Funds from Match, Source of Match, and the Total Funds from CF and Match *
Match Breakdown
Match Cash- Please provide each Organization Name, the Match Cash Amount, and whether it’s Pending or Confirmed *
Match In-Kind- Please provide each Organization Name, the Match In-Kind Amount, and whether it’s Pending or Confirmed *
Match Sweat Equity- Please provide each Organization Name, Number of Hours x $10, and whether it’s Pending or Confirmed *
Total dollar value of Match Cash, Match In-Kind and Sweat Equity *
Budget Narrative *
Notes
