Grant Application Grant Application 1Organization Information2Non-discrimination Policy3Grant Information4Narrative5Budget6Attachments Which application period are you applying for?(Required)Select the deadline date Spring Fall ORGANIZATION INFORMATIONOrganization Summary(Required)Provide a brief summary of your organization’s history, mission and goals, current programs, activities, and accomplishments.Organization Name(Required)The legal name of your Non-Profit Organization should be identical to the name on your IRS Tax Determination Letter and IRS Form 990Organization EIN #(Required)Organization Address(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Organization Phone(Required)The primary phone number for your organization.Organization WebsiteInclude the full URL including https:// or http://. Organization Executive Director/President/Chair Name(Required) First Last Organization Executive Director/President/Chair Email Address(Required) CONTACT INFORMATIONContact Name(Required) First Last Contact Email Address(Required) Contact Phone(Required) NON-DISCRIMINATION POLICYThe Roscommon County Community Foundation prohibits discrimination against current or prospective trustees, officers, employees and volunteers without regard to race, creed, color, ethnicity, national origin, religion, sex, sexual orientation, gender expression, age, physical or mental ability, pregnancy, veteran status, military obligations, and marital status. This policy applies to hiring, internal promotions, training, opportunities for advancement, and terminations. The Foundation’s grant making policies reflect the belief that organizational performance is greatly enhanced when people with different backgrounds and perspectives are engaged in an organization’s activities and decision-making process. Thus, the Foundation actively seeks to promote access, equity and inclusiveness, and to discourage discrimination based on race, creed, ethnicity, gender, age, sexual orientation, socioeconomic status, and other factors that deny the essential humanity of all people. This principle is a lens through which all the work of the Foundation is viewed. The Foundation reserves the right to decline proposals from organizations the Board and staff of which do not reflect the diversity of the community in which they work and live.Does your organization have a non-discrimination policy?(Required) Yes No Please describe your organization's non-discrimination policy.(Required)If you do not have a written policy, please explain how your organization implements non-discriminatory practices in its work. GRANT INFORMATIONList previous Grant Awards from RCCF in the last five (5) years(Required)Amount Requested from RCCF(Required)(please round up to the nearest dollar)Total Project Expense(Required)(please round up to the nearest dollar)Project Title(Required)Project Date(Required)Projects cannot start prior to June 1 for spring grant cycle or November 1 for fall grant cycle. Month Day Year Geographic Area Served(Required) NARRATIVEExecutive Summary(Required)Explain why your agency is requesting this grant. State whether this is a new or ongoing project. Describe the needs/problems to be addressed, the target population, and how you will spend the funds if the grant is approved.Purpose of GrantProject Goals(Required)Describe the goals, how you will measure success, and timetable for implementation of your project. What makes your project different from other projects that may be involved in similar efforts? Do you have long-term strategies for funding after the end of the grant period?Collaborative Efforts(Required)The screening committee encourages projects that demonstrate collaborative efforts between multiple organizations. Are there other organizations involved in this project? What are their roles and financial commitments? BUDGET NARRATIVE / PROJECT BUDGETIndicate only the income and expenses that apply to your project.INCOME List amounts requested of other foundations, corporations, and other funding sources. You must enter at least ONE income source, amount and description. To add additional sources, click on the + button at the right. You may enter up to ten.Income(Required)Income SourceIncome AmountPending or Committed Add RemoveEXPENSES You must enter at least ONE expense item/service, amount and description. To add additional sources, click on the + button at the right. You may enter up to ten.Expenses(Required)VendorExpense AmountDescription Add RemovePriority Items(Required)Indicate priority items in the proposed grant budget in the event that RCCF is unable to meet your full request. ATTACHMENTSType of Organization(Required)Please select your type of organization school government agency church 501 (c)(3) IRS Determination Letter indicating 501 (c)(3) designation or IRS Affirmation Letter indicating tax-exempt status if a school, government entity(Required)Provide a copy of your current IRS Determination Letter indicating 501 (c)(3) status or other document that proves you are an exempt organization. Drop files here or Select files Accepted file types: pdf, jpg, png, Max. file size: 12 MB, Max. files: 1. IRS Form 990 or 990-N, Audit or Financial Statement(Required)Provide a copy of your most recent IRS Form 990, Audit or Financial Statement. Drop files here or Select files Accepted file types: pdf, jpg, png, Max. file size: 12 MB, Max. files: 1. Organization Board Members(Required)To add additional entries, click on the + button at the right.NamePosition Add RemoveVideo Presentation Provide a five minute video presentation. Please upload your video file to a location/service on the internet where we can access it. Such locations could be Google Drive, Dropbox, YouTube, etc. Make sure you give info@myrccf.org rights to view or download the video.Video File Download URL(Required)Please provide a URL where we can view or download the video. Include the full URL including https:// or http://. This field is hidden when viewing the formCERTIFICATIONThis field is hidden when viewing the formCertificationTo the best of my knowledge and belief, statements in the foregoing application are true and correct; the document has been duly authorized by the governing body of the applicant; and the applicant organization will comply with applicable laws, regulations, terms and conditions in effect at the time of the grant. I understand that if our organization is awarded a Grant, receipt(s) must be presented within one (1) year for reimbursement. I certifiyThis field is hidden when viewing the formYour Name(Required) First Last This field is hidden when viewing the formYour Title(Required)This field is hidden when viewing the formToday's Date(Required) Month Day Year
