Online Grant Application | Greater Jefferson County Foundation

Date

Amount Requested

The EIN (Employer Identification) Number (also known as Tax ID #):

Name of Organization

Contact Person

Address

City

State

Postal / Zip Code

Phone

Cell Phone

Fax

This request is for

a Capital expense item an Operational expenses

I. Describe how these grant funds are to be used.

II. If a capital expense item, describe where item(s) will be placed in service and how it will be used.

III. Explain how this item or funds will be used to enhance your organization’s operation.

IV. List projected expenses for this request. How are cost estimates determined? If needed, attach a file below.

Attach any available quotes for this purchase. Limit attached estimates to one page.

Must be in PDF, Microsoft Excel or Microsoft Word Document format.

V. Briefly tell about your organization. (Include whom your organization serves, any benefits to residents of Jefferson County and the number of residents who will be affected by the awarding of this grant.)

If your grant request is for a capital item of $2,000 value or higher, or for OTHER than a capital purchase, attach a copy of the organization’s most recent balance sheet, and statement of revenues and expenditures. Applications will not be considered without this documentation.

Balance Sheet

Must be in PDF, Microsoft Excel or Microsoft Word Document format.

Statement of revenues & expenditures

Must be in PDF, Microsoft Excel or Microsoft Word Document format.

VII. Are you incorporated?

Yes No

Are you tax exempt?

Yes No

You must provide verification of your non-profit status. Provide us with a letter of determination from the IRS on your 501(c)3 status if you have applied for and received one. Attach a copy of the letter to this application. (This is NOT your tax-ID number) If you are a city/county entity, a verification letter is required to be attached to this document.

Applications will not be considered unless there is an IRS Determination Letter attached to the application, whether 501(c)3, Organization sponsored by the City or County Gov’t, etc...

Verification of your non-profit status.

Must be in PDF, Microsoft Excel or Microsoft Word Document format.

VII. Can your organization complete your project if GJCF partially funds your grant request?

Yes No

Budget Summary:

Grant Request Amount

The dollar amount requested from the Foundation.

Grant Request Amount Percentage

The percentage amount requested from the Foundation.

Other Funds

Monies other than the requested grant above. It means funds that are received from other grants, the City, the County, a private donation, etc.

Other Funds Percentage

The percentage of the above "Other Funds."

Are other funds committed?

Yes No Does your organization have the other funds in hand? Do you have a letter of commitment stating that those dollars are available to you? Is that portion of the money in your budget or elsewhere in the organization’s budget?"

Other Funds

Monies other than the requested grant above. It means funds that are received from other grants, the City, the County, a private donation, etc.

Other Funds Percentage

Are other funds committed?

Applicant Funds

Is the amount of monies your organization has or is raising from your own sources (money on hand, dues, bake sales, fund raisers, etc.)

Applicant Funds Percentage

The percentage of the above "Applicant Funds."

Are Applicant funds committed?

Yes No Does your organization have the funds in hand? Is that portion of the money in your budget or elsewhere in the organization’s budget?

Total Project Cost

Total Projected Cost Percentage

Has the Applicant applied for funds for this project from any other sources?

Yes No

If Yes, how much?

Was the request approved?

Yes No

If rejected, why?

If the request is funded, who will operate and maintain the improvements?

Has the project started?

Yes No

When will the project start?

List the amount of Grant Funds received from the Greater Jefferson County Foundation by your Organization / Entity during each of the past three (3) years:
(the organization is expected to keep records of their grant applications/disbursements, as stated in the signed Grant Agreement. Do not call/email the office asking for past disbursements amounts.)

Last Year

2 yrs ago

3 yrs ago

Your Full Name

Your Title

By checking the box below, you acknowledge that all of the statements and representations in the application are true and made for the purpose of obtaining a grant. Greater Jefferson County Foundation is authorized by you to obtain information about you as a grant applicant, consistent with your privacy rights and the foundation grant procedures.

I have read the above, understand the same, and consent thereto.