2017 Grant Application

Instructions

Before completing this grant application, please thoroughly review the A1 Spirit Foundation values and grant guidelines at spirit.a1ssi.com to determine your eligibility.

Grant Application Packages must arrive at the A1 Spirit Foundation by the proposal deadline and must include the following:

  1. Grant Application Cover Sheet (3)
  2. Grant Application (3)
  3. Verification of 501(c)(3) tax-exempt status and public charities status
  4. Organizational structure information
  5. Financial Information including organization budget, program budget (if requesting funds for a specific program or project), budget narrative (optional), and audited financial statements from the most recent year.

Please try to answer the Program Narratives section of the Grant Application in the allotted space. If additional space is required, you may attach additional sheets to complete your answer.

Incomplete applications will not be reviewed. Materials submitted that are not listed as part of the Grant Application Package above will not be considered during the application review.

Applications are the property of A1 Spirit Foundation; no part of the application will be returned.

Grant payments are normally made at the end of the month following the board meeting at which the funding decision was made.

Grant Application Cover Sheet

Date of Application:Click or tap to enter a date.

Legal Name of Organization:Click or tap here to enter text.
(Should be the same as on IRS determination letter as supplied on IRS Form 990)

Federal Tax-Exempt Number (EIN):Click or tap here to enter text.

Year Founded:Click or tap here to enter text.

Executive Director:Click or tap here to enter text.Email:Click or tap here to enter text.

Contact Person: Click or tap here to enter text.

Title (if different from Executive Director):Click or tap here to enter text.

Email:Click or tap here to enter text.

Address (principal/administrative office):Click or tap here to enter text.
City: Click or tap here to enter text.State: Click or tap here to enter text.Zip:Click or tap here to enter text.
Mailing Address, if different from above:Click or tap here to enter text.
Phone: Click or tap here to enter text.Fax: Click or tap here to enter text.
Website:Click or tap here to enter text.

Organization Mission: Click or tap here to enter text.

I certify, to the best of my knowledge, that:
1. The tax-exempt status of this Organization is still in effect, and
2. This Organization does not support or engage in any terrorist activity or other unlawful activity, and
3. Any funds granted will be used for program or programs designated in this application.

Signatures:

President, Board of Directors

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Executive Director

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Grant Application

Budgetary Information

Timeframe within which the funds will be used:Click or tap here to enter text.

Grant Request: $Click or tap here to enter text.

Organization’s Current Annual Operating Budget: Click or tap here to enter text.

Project’s Current Operating Budget (skip if general support):Click or tap here to enter text.

If requesting Program Support, list only funding from other sources that are directed to that Program.

Amount funded by other sources to date, for current operating budget:
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Amount funded by other sources pending, for current operating budget:
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If you do not receive the funds requested from A1 Spirit Foundation, will you be able to fund this program? Please explain. (For example: Yes, but our other programs will receive less funding. Yes, but the program will be cut in scope to reduce costs. No, this is an expansion program that would not be held without grant support. Etc.)

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If you receive funding beyond your program budget, what are your plans to utilize those funds?

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For General Support, please attach the completed Organizational Budget document. For Program Support, please attach both the Organization Budget and Program Budget documents.

Program Narratives

Programs or Project Name:Click or tap here to enter text.

Beginning Date of the Project/Campaign:Click or tap to enter a date.

Ending Date of the Project/Campaign:Click or tap to enter a date.

Purpose of Project or Programs:Click or tap here to enter text.

Geographic Area Served:Click or tap here to enter text.

Program focus: Choose an item.

Explain the need for this program focus in your Geographic Area served:

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How do the goals of this organization or program break the cycle:

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Implementation Overview (Briefly describe the program guidelines, expected outcomes, and plans for follow-up with participants):

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Action Plan.
Describe your program activities, strategies, staffing, partners, and timelines. Explain how the design will enable you to address the program or need. Identify the project as a new or continuing program.

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Results (how effectiveness will be monitored and evaluated, and your criteria for success):

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Continuation (plan for continuance of program/project at conclusion of requested funding):

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Please attach a brief description of at least 2 similar programs your organization has successfully run within the last 2 years. Include duration of program, geographic area, program focus, how the program “broke the cycle” for recipients, implementation and results.

Attachments

  1. Verification of 501(c)(3) tax-exempt status and public charities status.

I.Copies of the advance or definitive IRS determination letters indicating 501(c)(3) tax-exempt status and public charities status, or

II.Copies of the pages of the most recent 990 showing public charities status and public support.

  1. Organizational structure.

I.List of officers and directors, including occupations, places of employment, and other relevant affiliations.

II.List of key staff members, job descriptions of key personnel involved in the project.

  1. Financial information.
  1. Program/Project Budget
  2. Organizational Budget
  3. Audited Financial Statements. Include audited financial statements for the most recent year.
  4. Budget Narrative (optional)
  5. A list of assumptions on which the budget was based.
  6. An explanation of any unusual budget items.
  7. The percentage of overhead applied to the project should precede the itemized listing, if applicable.
  8. In-kind expenses and donations or matching funds should also be described.
  9. If your organization has affiliates and/or subsidiaries, please explain.

Please do not send videos or other unsolicited information.