2017 Grant Application Form

**Note: All sevencontact information lines and questions must be answered**

Organization Name:
Address:

Phone Number:

Grant Writer:
Email Address:
Program Director:

Email Address:

(Your organization is responsible for giving this information to the appropriate person in charge of your grant process)

Date:

1.Amount Requested $______is this a new program? Y N

2.Have you applied to another agency for this same request? Y N
A.If yes, to whom and for how much?

B.When will you know if you have received this grant?

3.Check area(s) of focus that best represents your request for funding:

___ Civic/Environmental
___ Arts/Culture
___ Education
___ Health
___ Recreation
___Agriculture
___Technology

4.In one sentence, tell us what you want to use the money for if your request is granted:

______

5.Describe the project or program for which funding is requested:

6.List the type of people you would be serving with this project/program:
A.Who will benefit?

B.How many will benefit?

7.Indicate the geographic area to be served:

8.What is thecommunity need for this request:

9.What is the work plan/timeline for this request:

10.Describe the plan by which this project/program will be evaluated:

11.How will project/program be funded in the future:

12.To only the original of your application, please attach the following:

  • List of your governing board and their business/professional affiliations.
  • Letter authorizing application for grant from your organization.
  • Current tax exempt status documentation: A copy of the organization’s most recent RRF-1 report for the State of California (not required of City of Gilroy nor accredited schools).
  • Last year’s financial statement of your organization (not required of City of Gilroy nor schools).

Note: Your attachments must be limited to these four items above.

13. Please complete this form by providing an itemized budgetof your project.

Project Budget

Revenues / Other Grants or Donations / In Kind Donations / Gilroy Foundation
Contracted Services
Donations
Fundraising
Program Fees
Other (explain)
Total Revenue
Expenses
Personnel
Travel
Equipment
Rent
Supplies
Printing
Postage
Training
Other (explain)
Total Expenses

Mail via US Postal Service: THE ORIGINAL and(7) copies of this application form to P.O. Box 774, Gilroy, Ca 95020.

Note: Completed forms must be postmarked by January 31, 2017.

Please no Certified Mail, - However, “Delivery Confirmation” can be purchased for your needs.

Hand delivery is also available by appointment only by calling the Foundation offices at 408.842.3727 or emailing

All applicants will be notified in March, with grant money being distributed in April at the Foundation’s Annual Meeting and Charitable Giving Presentation event.

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