Grant ApplicationThe following organization requests a grant from the Washington County Community Foundation:Organization Name: Mailing Address: Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Contact Person: First Last Phone:Email 501(c)(3) Organization Government Church or Synagogue If a 501(c)(3) organization, send in a copy of your IRS letter of determination or upload it here. Please follow the Documentation link for more detailed instructions on information that will need to be provided to the Foundation prior to approval.If a 501(c)(3) organization, send in a copy of your IRS letter of determination or upload it here. Please follow the Documentation link for more detailed instructions on information that will need to be provided to the Foundation prior to approval.Max. file size: 16 MB.Amount of Grant Request: Grant ProposalIn evaluating the merits of an application the following criteria are considered. Please respond to each item. Responses should be type written on a separate piece of paper with the question, followed by your response. Please limit your grant proposal to a maximum of four pages in length, plus any applicable attachments.1. Describe what the grant will be used for. Please be specific (i.e. what items will be purchased and their cost, what construction or repairs will be done, what program will be implemented, etc.) It is critical that you provide enough information to enable the Foundation to give your request full consideration.2. Describe how the proposed activity fits the Foundation's mission? (See "Mission" section)3. Describe how the proposed activity benefits the Foundation's service area of Washington County, Nebraska. Please be specific.4. How much of the community will the activity benefit?5. What personnel, resources, and experience does your organization have available to ensure that the project will be carried out according to plan? In addition, tell how many years your organization has been active in Washington County; give the names, titles, and phone numbers of the officers of your organization; and list recent projects your organization has completed in Washington County with a brief description and pertinent dates.Total Project Cost: Funds Available:(List sources. Cash/pledges raised for the project/program to date) Balance Needed:(The amount needed to be raised before receipt of a grant from the BACF. Subtract line B from line A.) 7. If the grant allocation given by the BACF were to be less than the amount requested would the project be able to proceed? Yes No If "yes," describe how the balance would be raised?8. What is the time period of the project and when will the grant funds be spent?9. If your proposal is for the benefit of another organization (i.e.: a parents' organization making a purchase for the school system) please document their agreement that there is a need and that they are in support of your efforts by including a letter from that organization. For public property projects (community buildings, public parks, etc.) provide a letter of support from the appropriate governmental body (i.e.: city administrator or city council, school administrator or school board, etc.)10. If the project will continue after the initial grant period, describe the plan to continue funding and/or maintenance in future years.Acknowledgement AgreementThe recipient agrees to indicate the assistance of the Washington County Community Foundation in press releases, publications, and other public activities associated with the project. If you are submitting additional paper documents, please be sure to make six copies of what you send.Applicant's Signature and title: SignatureDate: MM slash DD slash YYYY All applications received by the deadline of October 1 will be reviewed and final notification will be given to applicants by December 1. If you have questions contact Emily Petersen at 402-533-0194 or epetersen@washingtoncountybank.comPhoneThis field is for validation purposes and should be left unchanged.
