Flood Fund Application


ORGANIZATION INFORMATION
Name of organization
Legal name, if different
Address
Address
City, State, Zip
Phone
Fax
Web site address
 
Employer Identification Number (EIN)
   
Staff  
Number of full-time paid staff
Number of part-time paid staff
Number of volunteers
   
Top Paid Staff
Name
Title
Phone
Email
   
Applicant Information (The contact person regarding this application)
Name
Title
Phone
Email


Has this organization received a grant through the Community Fund, Momentum Fund, Linn County Endowment Fund field of interest or competitive donor-advised funds in the last 18 months?


PROPOSAL INFORMATION
Proposal Title
Top Funding Priority
Project dates (if applicable) through
Date of End of Fiscal Year


BUDGET  
Dollar amount requested $
Total project budget $
Total annual organization budget $


AUTHORIZATION
Top Paid Staff Name
Top Paid Staff Title
Organization Board Chair Name
Organization Board Chair Title


PROPOSAL NARRATIVE  
Please use the following outline as a guide to your proposal narrative.
 
I. Purpose of Grant

Situation
A : Opportunity, challenge, issue or need resulting from the June 2008 flood. 
300 word limit: 0 Words
   
B: Targeted population. Describe the demographics and targeted geographic area.
100 word limit: 0 Words
   
C: How the focus was determined and who was involved in the decision-making process. Please include community information/data used.
200 word limit: 0 Words
 
Proposal Design (please address all relevant items)
A: Overall goals and specific objectives to address the above situation
300 word limit: 0 Words
B: Levels of activity to be undertaken (daily intake, number of meals, additional staff hired to address emergency needs, non-profit stablization efforts); Estimated number of people to be served as a result of this proposal.
150 word limit: 0 Words
   
C: Criteria or circumstances for offering services. Are there eligibility requirements that must be met in order to receive services?
100 word limit: 0 Words
D: How the proposal complements similar work in the community.
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E: Do you know of any public funds that may be available for this proposal in the future?
100 word limit: 0 Words
   
II. EVALUATION  
Explain how you will evaluate and determine the success of this effort.
275 word limit: 0 Words
   
III. FINANCIAL INFORMATION  
Provide a brief budget and narrative identifying the estimated costs to implement the proposal.
100 word limit: 0 Words
What percentage will be used for administrative costs? %
 
If there are other sources of support, including public agencies and other private funders, please specify.
100 word limit: 0 Words
Please desribe how this grant will support activities that are not already being covered by state and federal support.
150 word limit: 0 Words
   
IV. ORGANIZATIONS NOT CURRENTLY GRANTEES OF THE GCRCF
      SHOULD SUBMIT THE FOLLOWING INFORMATION:
Is your organization an IRS 501 (c)(3) not-for-profit?
If no, is your organization a public agency/unit of government?
If no, check with Karla Twedt-Ball, GCRCF director of programs for details on using fiscal agents.
   
Name of fiscal agent
Address of fiscal agent
Fiscal agent's EIN number
   
Brief summary of organization mission statement, core goals and organization's programs.
150 word limit: 0 Words
 
The organization's relationship with other organizations working with similar mission. What is your organization's role relative to these organizations?
150 word limit: 0 Words
 
UPLOAD DOCUMENTS (on the next page)
Organizational documents requested from recent grantees
 (if you checked 'YES' to Receiving Competitive Grant in the past 18 months)
1) current year board-approved budget 
Organizational documents requested from all other applicants
1) current year board-approved budget 
2) Most current IRS determination letter (501(c)(3) letter)
3) One complete set of audited financials
4) List of board members and their affiliations
For non-501 (c)(3) organizations:      
1) Confirmation letter of fiscal agent (if required)
2) Fiscal agent financial statements
3) Signed fiscal sponsorship agreement


Note: After you proceed to document upload, you cannot go back to the application screen.