Grant Application | Community Foundation of Chippewa County

Grant Information

Title of Project

Organization

Amount Requested

Total Cost of Project

Date/s of Project

Contact Information

Contact Person/Proposal Writer Title Contact Email

Contact Phone

Ext.

Organization Mailing Address City

State

Zip

Organization Information

Organization Type

Other Organization

Federal Employer ID # (EIN)
If not applicable, leave blank. EIN # may only apply to 501(c)(3) nonprofit organizations Year Issued (EIN) Beginning Date of Fiscal Year

Total Operating Budget for Past Fiscal Year

Total Operating Budget for Current Fiscal Year

Chief Executive Officer/Title (CEO, Director, etc.)

Phone Number

Ext.

Name of Board Chair / Board President:

Phone Number

Ext.

Has your organization been awarded and received a Community Needs grant through the Community Foundation of Chippewa County in the past 3 years? If yes, provide grant info below: Yes No

Project Title

Amount

Year Grant was Received

Has this request been submitted to other local funding sources or received any funding as of this application? If yes, explain. Yes No

Explain the request submitted to other local funding sources.

Has the organization's governing body approved a policy which states that your organization does not discriminate on the basis of actual or perceived race, color, religion, national origin, sex, gender identity, sexual orientation, marital or parental status, political affiliation, military service, physical or mental ability, or any other improper criterion? If no, explain. Yes No

Explain...

Name of Authorized Representative as Electronic Signature

Date

Grant Proposal Narrative

Organizational Information (Limit of 250 words):
Please separate each response with the correlating number.

Provide a brief description of the organization's mission, goals, programs, and major accomplishments
Describe the population served (including total number) and geographic/demographic and socio/economic characteristics of those served in our community.

Grant Project Information (Limit of 500 words):
Please separate each response with the correlating number.

How does the project relate to the mission of the organization?
Who will benefit from the project and what geographic area is being served?
How will your organization carry out the project? Do you have a timeline?
Number of paid staff and volunteers involved in the project.
How will this grant increase the organization's capacity and/or access to the services it provides?
How will these proposed project goals and objectives be evaluated?

Grant Project Budget Summary (Limit of 300 words):
Please separate each response with the correlating number.

Please provide a detailed description of how proposed funds will be used along with the total costs of the proposed project.
If not fully funded by this grant, how will the remaining funds needed for the project be secured?

Project Budget:

Please attach a document or pdf of a detailed line item budget of your proposed grant project including all anticipated income for the project. This should include: pending and approved income, and all anticipated expenses for the project. Please also identify which expenses would specifically be covered by this grant request.
Example:

Computer = $200
Wireless Mouse = $30
Notebook = 40 x $1.25/each = $50

Grant total: $280

Required Attachments

You are requesting grants of $2,500 or more, please submit the following attachments.

Complete list of the organization's officers and board members with titles and contact information.

Organization's most recent annual operating budget showing all income and all expenses

If you have never submitted a grant application through the Foundation: For a 501(c)(3) nonprofit organization, upload a copy of your IRS 501(c)(3) tax exempt designation letter. For Government Agencies, Public Schools or Churches, please upload a cover letter from the leadership of your organization stating your charitable purposes as defined in section 170(b)(1)(A) of the Internal Revenue Code and your project's charitable intent.

For 501(c)(3) organizations: a copy of most recent IRS Form 990 tax return, 990-N or 990EZ

Community Needs
Grant Application

Grant Information

Contact Information

Organization Information

Grant Proposal Narrative

Required Attachments

Community Needs Grants: Funds Available

Arts and Culture

Community Development

Education

Environment & Animal Welfare

Health & Human Services

Thank You!

Your grant application has been successfully submitted. In a few minutes, you will receive an email confirmation that includes a copy of your grant proposal. If you do not receive this email, please call our office at 715-723-8125.

Request More Information

Community Needs Grant Application

Grant Information

Contact Information

Organization Information

Grant Proposal Narrative

Required Attachments

Community Needs Grants: Funds Available

Arts and Culture

Community Development

Education

Environment & Animal Welfare

Health & Human Services

Thank You!

Your grant application has been successfully submitted. In a few minutes, you will receive an email confirmation that includes a copy of your grant proposal. If you do not receive this email, please call our office at 715-723-8125.

Community Needs
Grant Application