Email Submissions Preferred. Attach All Documents in One Email To

Instructions:

·  Email submissions preferred. Attach all documents in one email to

·  If mailing, submit two copies of the forms and all required documentation as noted. A checklist is included at the end of this application.

·  Provide all requested information. Incomplete applications will not be considered.

Date of submission:

ORGANIZATIONAL INFORMATION

Contact Information

Organization Name:
Legal Name
(if different from above)
Executive Director
Primary Contact:
Title:
Street Address1:
Street Address2:
City, State, Zip:
Phone:
Email:
Website address:

Financial information:

Organization budget for most recent year: $

Fiscal year period:

Endowment balance at end of last FY:

Please briefly explain any major differences in income, expenses or endowment from previous fiscal year:

Top four funders to your organization during the past last fiscal year:

$
$
$
$

Board of Directors:

Number of board members:

Ethnic and gender make-up (by percentage):

Percentage that financially supports organization:

If less than 100% support from board, please explain:

Specialties represented on board (i.e. education, technical, HR):

Organization Mission Statement:

Organization History:

PROPOSAL SUMMARY

Name of project:

Geographic Location of Community Served:

Age range of youth to be served:

Demographics of community to be served:

Project budget: $

Amount requested: $

Names and amounts of other funders for requested project/program:

Committed

/

Pending

$ / $
$ / $
$ / $
$ / $
$ / $

Project Narrative
Provide the following information as an attachment. All statements must be addressed in your narrative and please include the statement as a subheading of the paragraph.

1.  Summarize project, including how it is aligned with the Subaru of America Foundation focus.

2.  Project need and goals, including how you will measure results.

3.  Collaboration with other organizations.

4.  Targeted audience and approximate number of youth who will benefit.

5.  Impact statement for project.

6.  Project timetable

7.  Indicate any Subaru relationship other than with the SOA Foundation over the past 18 months.

8.  How will the project change if you receive less than requested or if the project is not funded by Subaru?

EXECUTIVE DIRECTOR CERTIFICATION

I certify that the information included in this proposal is correct and accurate; that the organization’s IRS tax-exempt status is still in effect; and that should a grant be awarded, it will be used for the purposes stated in this proposal.

Print Name:
Title:

Date:

CHECKLIST FOR REQUIRED ATTACHMENTS

Completed application. Please limit program narrative to no more than three typewritten pages.

Detailed project budget

Itemized organizational budget for current fiscal year, showing actual figures
for previous fiscal year

Brief descriptions of key staff and qualifications

Board of Director list including affiliations

Most recent audited financial statements or Form 990 if no audited statements, or P&L Statement signed by executive director if income is less than $50,000 (and don’t have to file a full form). We cannot accept form 990-N/postcard.

IRS 501(c)3 letter

CONTACT INFORMATION

Email submission:

Questions? Contact:

Sandy Capell, Foundation Manager P: 856.488.5099

Subaru of America Foundation, Inc.

2235 Route 70 West | Cherry Hill, NJ 08002