Hootie & The Blowfish Foundation Grant Application
GENERAL AGENCY Information
Date of Application: / EIN#:Name of Organization:
Mailing Address:
Physical Address:
Phone #: / Fax#:
Website: / Organization Email:
Executive Director:
Executive Director’s Phone: / Email:
Organization’s Mission:
Annual Organization Budget:
Organization Interest Area (Check all that apply):
Animal Welfare / Arts/Culture / Civic Engagement / Community Development
Education / Employment / Environment / Health
Housing/Homelessness / Human Services / Philanthropy/Volunteer / Public Protection
Recreation / Religion / Technology / Youth Development
Geographic Locations Served (Check all that apply):
Calhoun / Clarendon / Fairfield / Kershaw / Lee / Lexington
Newberry / Orangeburg / Richland / Saluda / Sumter
Other (Please list)
Population Served (Check all that apply):
Race/Ethnicity / Gender / Age Groups
African American/Black
Asian or Pacific Islander
Hispanic/Latino
Caucasian/White
Other / Female / Male / Young Children (0 – 5)
Children (6 – 12)
Youth (13 – 18)
Adults (19 – 64)
Seniors (65+)
project information
Project Contact Person/Title:(if other than Executive Director)
Contact Person’s Phone #: / Email:
Project Title:
Project Description:
Project Timetable:
Geographic Locations Served (Check all that apply):
Calhoun / Clarendon / Fairfield / Kershaw / Lee / Lexington
Newberry / Orangeburg / Richland / Saluda / Sumter
Other (Please list)
Population Served (Check all that apply):
Race/Ethnicity / Gender / Age Groups
African American/Black
Asian or Pacific Islander
Hispanic/Latino
Caucasian/White
Other / Female / Male / Young Children (0 – 5)
Children (6 – 12)
Youth (13 – 18)
Adults (19 – 64)
Seniors (65+)
Amount Requested: / Total Project Budget:
Board Chair (Please Type/Print) / Executive Director (Please Type/Print)
Board Chair Signature / Date / Executive Director Signature / Date
Grant Checklist
Please check the items that are true for your organization.
The following information will be helpful to the Community Impact committee when reviewing the grant proposals for each cycle. Sign and attach the completed form to your proposal. If you have any questions please contact our office at 803.254.5601 or email .
Please DO NOT send the items as attachments. However, please be prepared to provide proper documentation of this information to the Community Impact committee upon request.
Our organization has:
An Internal Revenue Service 501(c)(3) tax exemption letter.
A charitable registration letter from the South Carolina Secretary of State's Public Charities Section or a current letter stating that our organization is exempt from registration.
Operating by-laws and articles of incorporation.
A vision, values and mission statement.
Copies of Board of Trustee meeting minutes over the last 12 months.
Copies of the most recent financial documents:
Audited Financial Statements Reviewed Financial Statements
Compiled Financial Statements IRS Form 990
A current strategic plan.
A current annual report.
An organizational chart.
A conflict of interest policy.
A whistleblower policy.
Name & Title (print)
Organization
Signature Date