Grant Application Form(2/2015)
Greenbelt Community Foundation
This form may be downloaded from typed into and then printed or emailed– deadlines are April 15 & Oct 15 / Submit completed form by mail to: Greenbelt Community FoundationP.O. Box 234, Greenbelt, MD 20768 or
by email to:
1. Name of Organization:
2. Address of Organization:
3. Type of Organization (check one):__ Nonprofit Corporation
__ Association
__ Not for Profit Cooperative
__ Other (please explain):
4. Name and Title of Person Submitting Application:
5. Address:
6. Phone:
7. E-mail:
8. Brief Description of the Organization: (1 paragraph):
9. Title of Proposed Project:
10. Brief Description of the Project: (1 paragraph):
11. Project target area (check all that apply):__ Greenbelt East
__ Greenbelt West
__ CenterGreenbelt
12. Amount of Funding Requested: $
13. Signature: Date:
14. Listofboardmembersindicatingofficersandterms.
15. Briefhistoryoftheorganizationwithrecentaccomplishments.
16. Names, roles and qualifications of administrators and service providers key to the success of this project.
17. Organizationalbudgetforthisyearincludingincomeand expense (do not include funding requested in this application).
18. ProjectDescription(upto3pages)specificallyaddressing:
•Objectives of the project and its expected impact on Greenbelt residents.
•Who the project will serve - ages, gender, location.
•State how this project is a new undertaking.
•Specific steps to be taken to implement the project.
•How you will know you are being effective.
•Project timeline including start date, end date, and important milestones.
•Letters of Support or Memoranda of Understanding from partners orother organizations involved in the project, or whosecooperation and/or approval is necessary.
•If the project is to continue for more than one year, what plans are you
considering for future funding?
19. ProjectBudget(1page)–organized byIncomeandExpense:
•(Income) Amount requested from the Greenbelt Community Foundation.
•(Income) All other funds for the project and their sources. If pending,indicate the date you expect notification.
•(Income) Donated or in-kind materials or services committed to the project and theirsources.
•(Expense) Itemize the projected costs highlighting the specific itemsto be funded by the Greenbelt Community Foundation.
20. Copy of your current IRS tax-exempt determination letter with federal tax-exempt number. If tax-exempt status is pending or not applicable, explain.
a. If not incorporated as a 501c3, provide a letter from a qualifying organization willing to act as the fiscal agent for the project. The letter must include the fiscal agent organization’s mission statement and attach a copy of its current IRS determination letter.
b. A corporation organized as a cooperative may apply if “Not-For-Profit” is clearly indicated in its Articles and By-laws.
Proposals are evaluated based on responses to the questions above.
Any additional material provided will likely not be helpful.
Proposals will be evaluated using the categories:
Value to Greenbelt, Clarity of plan, Feasibility of approach, Qualifications of administrators & service providers, Likelihood of success, Appropriateness for GCF support, and Potential for sustainability (if planned). Each category is weighted equally.
If your proposal is selected for an award, a final report on your project, including photos and accounting for the expenditure of the grant funds, is required at the conclusion of the project.
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