7#8   8 88 <888888The Community Foundation of Wabash County 218 East Main Street  P.O. Box 98 North Manchester, Indiana 46962  Phone (219) 982-4824, Fax (219) 982-8644 Web: www.cfwabash.org  E-mail: info@cfwabash.org Grant Application Form (PLEASE TYPE) NAME OF ORGANIZATION ____________________________________________________ IF FUNDED, PLEASE LIST THE EXACT LEGAL NAME OF THE ORGANIZATION TO WHICH THE GRANT WOULD BE PAID _____________________________________________________________________ CONTACT____________________________________________ TITLE_________________________________ ADDRESS________________________________________________________ ZIP ________________________ PROJECT LOCATION___________________________________ TELEPHONE __________________________ PRESIDENT OR CHAIR OF GOVERNING BOARD_________________________________________________ TITLE OF PROJECT___________________________________________________________________________ INCLUSIVE DATES OF PROJECT_______________________________________________________________ BRIEFLY DESCRIBE YOUR PROPOSED PROJECT: AMOUNT OF GRANT REQUESTED: $_______________  GRANT PROPOSALS MUST INCLUDE THE FOLLOWING: 1. TEN COPIES of the completed application form, using the space provided or your own paper following the sequence and names of items on the form. ONE COPY of each of the following: 2. Complete budget for proposed project. 3. List of members of governing board. 4. Most recent financial audit or year-end financial statement. 5. Current month and year-to-date statement of operations. 6. Copy of 501(c)(3) tax exemption letter from the Internal Revenue Service Grant Application Form PAGE TWO 1. ORGANIZATION. Briefly describe the history and purpose of your organization. 2. NEED. List issues or needs which this project will address. 3. PURPOSE. Describe specifically how this project will serve the identified issues or needs. 4. WHO WILL BE SERVED. Describe who and how many persons will be served by this project. Indicate the geographic area served. 5. PERSONNEL. List names, functions, and qualifications of employed staff and volunteers involved in the project. Employees: Volunteers: Grant Application Form PAGE THREE 6. COORDINATION. Indicate others in the community working on this issue, how your proposed project coordinates with them, or what you propose to do better or different from existing programs. 7. MANAGEMENT. Give indication of your organizations ability to implement this project effectively. 8. EVALUATION. Explain how you will determine whether the objectives of your project are accomplished. (NOTE: If a grant is awarded for this proposed project, a final report must be submitted to the Community Foundation upon completion of the grant period.) 9. OTHER. Provide anything else you would like the Community Foundation to know about this project. 10. FUNDING PLANS. Will this program continue in the future? If so, how will it be funded? Grant Application Form PAGE FOUR 11. PROJECT BUDGET. Please present a realistic line item estimate of project costs. If project costs exceed grant request, indicate the source(s) of other funds. 12. CERTIFICATION. To the best of my knowledge and belief, statements in this grant 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 the Community Foundation, in evaluating this grant application, may, if it deems appropriate, review any and all of the information submitted as part of this request with advisors of the Community Foundations choosing. _________________________________________________ ____________________ SIGNATURE OF PRESIDENT OR EXECUTIVE DIRECTOR DATE SUBMIT APPLICATION TO: The Community Foundation of Wabash County P.O. Box 98 North Manchester, IN 46962 h<5.5=d WORD=*@Ano>[\]_(BXYZq{  ! y r } w } ~{@ H0 Z l jl*+N>BO-./0\^_Bk YZqz{      ļ  h 0hh 0hhh3   u v w x y r } ~  w x y z { | } T Uh h h h    5 U V W X Y Z jklʿ h h h3'table of authorities Body Text 2" Dh     =/B<)The Community Foundation of Wabash County Andrew Duffy Times New RomanSymbol#Times New Roman CE$Times New Roman Cyr&Times New Roman Greek'Times New Roman Tur(Times New Roman (Hebrew))Times New Roman (Arabic)*Times New Roman Baltic PBrushBM6(L Anon_Obj_0\H`]H