Name of organization:enter organization name
Contact person and title: enter contact name & title
Phone and email: enter contact phone & email
Second contact person and title: enter 2nd contact name & title
Phone and email: enter 2nd contact phone & email
Address: enter address
City: enter cityState: enter stateZip: enter zipcode
Website: enter website
Type of Grantmaker:
☐Corporate Giving Program☐Corporate Foundation
☐Community Foundation☐Family Foundation
☐Independent Foundation ☐Public Foundation
☐Other:Click here to enter text
Year Founded: enter text Number of Paid Staff: Full-time: enter text Part-time: enter text
Write a brief statement about your organization’s funding areas.
Click here to enter textCheck any of the areas in which you fund:
☐Aging☐Higher Education
☐Arts, Culture & Humanities☐Housing & Shelter
☐Children & Youth Services☐Human Services
☐Civil Rights, Social Action☐Medical Research
☐Community Improvement &☐Mental Health & Crisis Intervention
Capacity Building☐Out-of-School/After School
☐Crime/ Courts/Legal Services☐Public Affairs & Societal Benefit
☐Diseases, Disorders & Medical☐Public Safety, Disaster Prep & Relief
Disciplines☐Recreation/Sports/Leisure
☐Early Childhood☐Science & Technology
☐Economic Development☐Special Education
☐Education☐Women & Girls
☐Employment/Jobs☐Workforce
☐Environment & Animals☐Youth Development
☐Equity and Inclusion☐Youth Violence Prevention
☐Food, Agriculture & Nutrition☐Not Classified/Unknown
☐Health
Briefly describe those areas that you do not fund.
Click here to enter text
Please give a brief statement about the geographic areas that your organization funds.
Click here to enter text
Financial Data
Please provide the following data for the most recently completed fiscal year.
Fiscal year:enter fiscal year
Total assets: $enter assets Total grants: $enter grantsTotal CT grants: $enter CT grants
Do you accept unsolicited requests?☐Yes ☐No
Please check which types of support you give:
☐Capital campaigns ☐Emergency funds
☐General purpose/operating☐Program-related investments
☐Project support☐Student aid (to institutions)
☐Technical assistance☐Other
If you represent a corporate foundation or giving program:
Does your organization have a matching gifts program?☐Yes ☐No
Does your organization have a grants program to support organizations where employees volunteer?☐Yes ☐No
Membership Support Schedule
Membership support is on a sliding scale, determined according to each member’s total giving in Connecticut as averaged over the most recent 3-year period. This annual support is based on the calendar year.Membership support may be paid in the form of a grant.*
Calculate 2018Support:
Step 1:Add 3-year CT total grants
CT total grants FY 2017:$Click here to enter text
CT total grants FY 2016:$Click here to enter text
CT total grants FY 2015:$Click here to enter text
Total 3years above:$Click here to enter text
Step 2:Divide Total by 3 for
Grantmaking Average:$Click here to enter text
Step 3:Use the Membership Support Schedule on the left to determine your
support level according to your Grantmaking Average:
2017 Member Support:$Click here to enter text
Consider a2018 Leadership Fund Contribution
For other ways to support CCP, consider contributing to the Leadership Fund. Please contact CCP at 860-525-5585 for more information.
Add Total Support:
Enter Membership Support*:$Click here to enter text
Enter Leadership Fund Gift*:$Click here to enter text
TOTAL 2018 Support:$Click here to enter text
*☐Check here if a grant application is needed.
CONNECTICUT COUNCIL FOR PHILANTHROPY