Grant Application Form | Midlands Community Foundation

Midlands Community Foundation

Grant Application Form

Authorized Signature (CEO, Executive Director)

Briefly describe the applicant organization, its programs and population served.

Brief description of the project/program for which you are seeking funds.

Service area of project/program for which you are seeking funds (allocate if necessary).

Total cost of the proposed project/program:

$

Amount requested from Midlands Community Foundation:

$

Funding period

From: To:

Indicate the category which best describes the purpose of the grant (describe in more detail below if necessary):

Education

Arts/Culture

Community/Civic

Economic Development

Health

Recreation

Human Services

Budget for project or program for which you are applying for Midlands Community Foundation grant funds. Attach documentation if available. In-kind donations and tax supported funding (federal and state) also should be listed.

Sources of funds (list):
and amount of each

Total Revenues:

$

Expenses (list):

Total Expenses:

$

Additional information that may be helpful in understanding the above budgetary figures.

A. PROBLEM/PURPOSE: Describe what the project will accomplish, what benefits it will provide and what community need it will meet.

B. IMPLEMENTATION: How will this project be accomplished? By whom, where, when, etc.? Provide numbers and timetable.

C. SIZE AND DURATION: How many people will be served or affected by this project and for how long? What percentage of the people served or affected are Sarpy or Cass county residents?

D. COORDINATION: Who else is addressing this need? Are there any coordination efforts between you and them? How does this project's approach differ from other already established efforts?

E. CONTINUATION: Will this project require continued funding? If so, identify the source of this future funding.

F. EVALUATION: Once completed, explain how your project has accomplished its purpose.

All applications must include the following supporting documents (one copy):

Federal tax exemption letter.
Financial statements audited for the most recent fiscal year. (if no audited financials, then most recent board-approved financials)
Operating budget for the current year including principal source of income.
Copy of organization’s by-laws.
If applicable, school-based grant requests must submit a written confirmation letter that the proposed program has been reviewed and accepted by the selected schools district(s).