Grant Applicaton | New Albany Community Foundation

Applicant Information

Applicant Name

Applicant Title

Applicant Phone Number

Applicant Email

Organization Information

Legal Name of Organization

Mission Statement

Website

Add https:// in front of your web address

Email

Year Founded(Required)

Engagement Year(Required)

Year Organization Began Engagement Within the New Albany Community

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is the mailing address the same as the physical address?

Use a different physical address

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Financial Information

The organization applying for the grant funding is (Check one):

A non-profit organization recognized by the IRS as 501(c)(3).

A student organization applying under NAPLSD

Upload an approval letter from the NAPLSD Superintendent(Required)

Accepted file types: pdf, doc, docx, odt, Max. file size: 50 MB.

IRS Affirmation or Determination Letter(Required)

Accepted file types: pdf, doc, docx, odt, Max. file size: 50 MB.

*Upload a current copy of the IRS Affirmation or Determination Letter denoting the 501(c) status of the organization*

Did you file form 990 last year?(Required)

Yes

No

Upload Form 990(Required)

Accepted file types: pdf, doc, docx, odt, Max. file size: 50 MB.

*If your non-profit organization filed Form 990 last year, please upload a copy.*

Upload Most Recent Financial Statement(Required)

Accepted file types: pdf, doc, docx, odt, Max. file size: 50 MB.

*If your non-profit organization did not file Form 990 last year, please upload a copy of your most recent Financial Statement.*

Taxpayer Identification Number(Required)

Total Organization Revenue (Current Year)

Total Organization Revenue (Prior Year)

Primary Sources of Revenue (Current Year)

Primary Sources of Revenue (Prior Year)

Start Date of Fiscal Year

Primary Sources of Income

Grants, Fees, etc.

Total Endowment

Total Reserves

Total Debt

Board Information

Name of Chair of the Board

# of Board Members

# of Staff

# of Volunteers

Names of any NACF Board Members on your Board

Use the plus icon to add additional board members. One member per line.

% of Board Providing Financial Support to Organization

Please enter a number from 0 to 100.00.

Previous NACF Awards

Please list all grants awarded by NACF to your organization over the past five years. If you did not apply, type 'yes' in the "Did Not Apply" box for the appropriate year(s); if you applied and were not funded, type 'no' in the "Grant Funded" box for the appropriate year(s).

Grants Awarded

Year

Did Not Apply

Grant Funded

Amount Awarded

Purpose of Request or Completed Project

*Follow-up report from most recent grant must be filed prior to applying for a new grant. *

Program/Project Information

Name of Program/Project

Brief Statement of Purpose

Amount Requested

Anticipated Program/Project Start Date:

Upload Budget(Required)

Accepted file types: pdf, doc, docx, odt, xlsx, xls, Max. file size: 100 MB.

*Budget for this program/project must be uploaded*

Total Program/Project Cost

Anticipated Program/Project Completion

Amount Allocated from your Organization

Other Funders for this specific program/project

Funders Name

Amount

State of commitment (Committed, Pending, Not yet)

*The foundation does not expect to be the sole funding source for any program or project.*

Check the Foundation Pillar that applies to program or project:

Lifelong Learning

Arts

Health and Wellness

Environment

Program Execution

Summarize the program/project's objectives, implementation methods, whom and how many people will be served, a plan for self-evaluation and future funding plans.

A follow up grant report that includes expenditures and evaluation of the program/project will be required of grantees. Outline the plan to document your progress and/or results, if awarded a grant for this program/project.

Application Signature

By submitting your name below, you are signing this grant application and acknowledging that the information herein is accurate.

Name

First Last

Title

Date

About the Foundation · Funds & Grants

Grant Application

Applicant Information

Organization Information

Financial Information

Board Information

Previous NACF Awards

Program/Project Information

Program Execution

Application Signature