LEHIGH VALLEY COMMUNITY FOUNDATION

The Lehigh Valley Helping Hand Fund

Instructions Sheet

(Do not attach to application)

Applications will be accepted from invited organizations for programs in Lehigh and Northampton Counties. Every grant must be used for the program or purpose for which it is requested.

Because the grants review process is complex and comprehensive, you must:

  • Use the attached application form or an exact replica of the format.
  • Respond to all questions using the space shown. Applications exceeding two sheets/four pages will not be considered.
  • DO NOT send a cover letter or any additional materials. They will be discarded.
  • Be prepared to announce the grant and to adequately and appropriately publicize the grant.

If you have specific questions concerning this application form, please contact the Foundation office at

610-266-4284, or fax: 610-266-4285; or e-mail: ). A member of the staff will contact you as soon as possible. The recommendations of the Lehigh Valley Helping Hand Committee and the decisions of the Board of Governors are final.

COMPLETED APPLICATIONS MUST BE RECEIVED BY 5:00 P.M. SEPTEMBER 4, 2012.

APPLICATIONS WILL NOT BE CONSIDERED IF THEY ARE:
PERSONALLY DELIVERED AFTER 5:00 P.M. ON SEPTEMBER 4
POSTMARKED AFTER SEPTEMBER 4

Applicants are encouraged to email their applications to

For those not able to email their applications, they may be faxed to 610-266-4285 or mailed to:

The LV Helping Hand Committee, Lehigh Valley Community Foundation,

968 Postal Road, Suite 100, Allentown, PA 18109

NOTE: LVCF uses the National Taxonomy of Exempt Entities (NTEE) Classification System as a way to classify organizations. An organization’s mission, as reflected in its NTEE code, not the program for which it is seeking funding, determines how it is classified. This requires you to know your NTEE category, which can be found on your Guidestar report. The report can be found at . Enter your organization’s name or Employer Identification Number in the search box, and then select your organization from the resulting list. The NTEE category can be found on the right hand side of the report.

One NTEE code is assigned by the IRS upon initial approval of a nonprofit’s status. This code can be changed by the organization. Many nonprofits choose to adjust their classification on their GuideStar profile to more adequately reflect their mission.

DO NOT RETURN THIS SHEET – for instruction purposes only

The Lehigh Valley Helping Hand Fund

APPLICATION FOR A GRANT IN FY 2012-13

The Lehigh Valley Helping Hand Fund was founded by local business leaders to provide grants for charitable programs and organizations that meet the needs of those who “fall through the cracks” in the provision of social and human services.

1.Tell us who you are: The name of your organization, its purpose or mission, the people or area

it serves, and its primary activities.

Organization Name

Address

Employer ID # ______NTEE Code ______Phone # Fax #

Website Email ______

Contact NameTitle

2. What are you requesting? What is the amount of the grant you are requesting? What is the

program or project for which you want support? How will Helping Hand grant dollars be used?

3. What do you hope to accomplish? What are the specific objectives of the project for which you are requesting a Helping Hand grant? Who will be served by the program? In what ways?

4. How will you know you've succeeded? What are the measurable outcomes of your program? What are the results which will be evident? What will be the impact of this program on the need being addressed or the population being served? Is there potential for this program to become self-sustaining or to leverage additional support or benefits in the community?

SECTION A – PROGRAM FUNDING INFORMATION

Program/project funding

Funding received/committed to date$ ______a

Amount requested from Lehigh Valley Community Foundation ______b

Additional funding sought/expected ______c

Total program/project funding (budgeted cost)$ ______= a+b+c

% of program/project cost represented by this request ______= b÷ (a+b+c)

SECTION B - ORGANIZATION FINANCIAL DATA

Please indicate which tax form(s) you filed, if any, and follow the instructions for that line.

_____ Our last two tax returns were Form 990 and/or Form 990-EZ. Provide the indicated information below.

_____ We filed Form 990-N (the e-Postcard form). Provide a copy of your Form 990-N with this application. Provide the indicated information below.

_____ We are not required to file Form 990, 990-EZ or 990-N. Call LVCF at 610/266-4284 for further instructions.

FormForm 990-EZ Form 990Most Recent 990/990-EZ

Month Fiscal Year Ended ______990-NPart & Line #Part & Line #Year _____Year _____

RevenueForm _____Form _____

Contributions and grantsI-1I-8$ ______

Program service revenueI-2I-9 ______

Investment incomeI-4,5I-10 ______

Other revenueI-3,6,7,8I-11 ______

Total Revenue XI-9I-12 ______

Expenses

Program servicesIX-25 col. B ______

Management & generalIX-25 col. C ______

FundraisingIX-25 col. D ______

Total Expenses XI-17IX-25 col. A ______

Excess or (Deficit) XI-18I-19$ ______

Net Assets

UnrestrictedX-27$ ______

Temporarily RestrictedX-28 ______

Permanently RestrictedX-29 ______

Total Net Assets XI-21I-22$ ______

SECTION C - ENDOWMENT INFORMATION

Does the organization have an endowment? YES _____NO _____

If yes, please answer the following questions:

Do you use endowment income for operations and/or

programs in your annual budget?YES _____NO _____

If not, why? ______

Is (are) the organization’s endowment fund(s):

____Board designated-invested by organization (included in Form 990 Part X Line 27)

____Donor established-invested by organization (included in Form 990 Part X Line 29)

____Separately incorporated & invested (not included in Section B above)

If separately incorporated and invested, please provide the following information for that entity:

Name______

EIN______Form 990 Part I Line 22 ______

Call the Foundation at 610/266-4284 if you have any questions about the Financial Data page.

Applications that do not comply with the requirements below will not be considered.

Please check off and send an original plus 5 copies of this application with a copy of the following attached to the original and to each copy of your application:

1.List of your organization’s Board members’ names and occupations.

2.Proposed total budget for the program/project for which funding is requested.

Please check off and send the original application and the following items:

______1.List of your organization’s Board members’ names and, if available, city of residence and occupation.

2.Proposed total budget for the program/project for which funding is requested.

______3. A copy of the Independent Auditor’s Report (not the entire audit) which accompanied your most recent audit. This letter is usually the first page of the audit following the table of contents.

______4.A copy of your current Certificate of Registration from the PA Bureau of Charitable Organizations OR a letter stating why you are not required to register.

______5.If applicable, a copy of your most recent 990-N (the e-Postcard form).

At the conclusion of this grants process, if your application is unfunded, the Lehigh Valley Community Foundation would like to make it available to other grantmakers, donor advisors, and funders in the Lehigh Valley. We will do so only if we have your permission to share your application. Please indicate whether or not you would like to participate in this process.

The Lehigh Valley Community Foundation  does  does not

have permission to share this application with other potential grantmakers.

By signing this application, the undersigned verifies having authority to submit this application for the applicant organization.

Signature Date

Printed name Title