INDIANAHORSE COUNCIL FOUNDATION, INC.
HELPING HORSES AND HUMANS FUND
GRANT APPLICATION
*Please review the grant application guidelines prior to completing this document.
Helping Horses and Humans Fund Mission
The Indiana Horse Council Foundation, Inc. created the Helping Horses and Humans Fundas a designated fund to implement or support programs to provide adoption or retirement opportunities for horses, retrain horses for therapeutic use or other second careers, and assist organizations dedicated to the use of retired or retrained horses in equine therapy for human rehabilitation (collectively, the “Fund Purposes”).
APPLICATION
Name of Grant Project:Amount Requested:
Proposed Project Start Date:
Anticipated Project Completion Date:
(Funds for approved grants will be disbursed within sixty(60) days of approval.)
1. Name and Address of Applicant/Organization:______
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2. County:______
3. Telephone:______
4. Fax:______
5. Email:______
6. Website:______
7. A. Federal I.D. Number ______
B. Evidence of Non-Profit Status:
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8. Brief History of Applicant/Organization (maximum 150 words):______
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9. Contact Person:______
A. Address of Contact Person (if different from above):______
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B. Telephone(if different from above):______
C. Fax (if different from above):______
D. Email (if different from above):______
E. Website (if different from above):______
F. Brief Biography of Contact Person (maximum 100 words or, alternatively, please attach Curriculum vitae):______
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10. Statement of the Purpose of the Grant:______
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11. State How the Purpose of the Grant Serves the Fund Purposes:______
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12. Check the Box(es) That Best Describe(s) the Goal(s) of Your Project(check all that apply, maximum 3):
____ Equine Rescue/Rehabilitation____ Equine Retirement
____ Equine Assisted Therapy (Adult)____ Equine Assisted Therapy (Child)
____ Equine Assisted Activities (Adult)____ Equine Assisted Activities (Child)
____ Adoption ____ Second Careers
____ Retraining____ Education
____ Facility Development____ Promotion
____ Research____ Equine Health
____ Awareness____ Companion Animal
____ Other(please describe, maximum 50 words)______
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13. Summarize How the Project Will Further the Above-Stated Goal(s)(maximum 150 words):
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14. StateWho Will Benefit from the Project:_________
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15. Provide a Brief Breakdown of the Anticipated Use of the Grant Funds(please list specifics related to the project and their associated costs):_________
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16. State the Anticipated Project Completion Date:_________
17. State How Your Organization Will Acknowledge This Grant to:
A. Your Members:
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B. The General Public:
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18. Other Funding Sources:
A. Please Check Whether You Anticipate Other Funding Sources for the Project (i.e., Matching Funds, Donations, In-Kind or Service Donations, Advertising, etc.):
______Yes ______No
B. If Yes, Please:
i. Briefly State the Nature of the Other Funding Sources (maximum50 words):
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ii. State the Anticipated Dollar Value from Each of the Other Funding Sources:
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19. List Any/All Project Collaborators:
A. Name of each Collaborator:______
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B. Role of each Collaborator in the Project (maximum 50 words):
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C. Brief Description of each Collaborator (maximum 50 words):
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D. Address of each Collaborator:______
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E. County:______
F. Telephone:______
G. Fax:______
H. Email:______
I. Website:______
J. Is Collaborator a Not-For-Profit or Non-Profit Organization?: _____ Yes _____ No
20. Prior Grants through the Indiana Horse Council Foundation, Inc.
A. Please state whether Your organization has ever applied for a grant from the Indiana Horse Council Foundation, Inc. before: _____ Yes _____ No.
B. If Yes, please state the year received and the amount awarded:______
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21. Please state whether Your organization has declared Bankruptcy within the last seven years: _____ Yes _____ No (If yes, additional information may be required at the sole discretion of the Indiana Horse Council Foundation, Inc.)
22. Please initial in the space provided to acknowledge that You understand and agree:
A. Within sixty (60) days of the first occurring of either the project’s anticipated completion date (as stated above), or upon depletion of the grant funds, You shall submit a project report describing the project accomplishments and documentation of the use of the grant funds(including copies of receipts, associated contracts, etc.); and
B. Further, that failure to timely submit said project report will render Your organization ineligible for future grants from the Indiana Horse Council Foundation, Inc.(extensions may be requested if made within the sixty (60) day time period in which the project report initially would be due. The Indiana Horse Council Foundation, Inc. shall have sole and complete discretion as to whether such extensions should be granted).
______Yes, I understand and agree.
(initials)
23. In the event the Indiana Horse Council Foundation, Inc. approves this grant request, please state:
A. Name of the party to whom the check should be written:______
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B. Address where the check should be mailed:______
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Signature of Authorized Agent for Organization:______
Printed Name:______
Title of Authorized Agent for Organization:______
Date Signed:______
* The complete, signed Grant Application together with all attachments must be received on or before either the March 1st or the September 1st deadline to be eligible for the grant in each calendar year, and must be either electronically submitted to the Indiana Horse Council Foundation, Inc., , or may be mailed to:
Indiana Horse Council Foundation, Inc.
Attention: Grant Coordinator
Communications Building
1202 East 38th Street
Indianapolis, In 46205-2869
For questions or assistance, please contact the Indiana Horse Council Foundation, Inc.,at:
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