Grant Application Form

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Organization Name (and legal name if different) / Amount Requested / Date
Federal Tax ID Number

Please complete all fields and questions. Attach separate sheets as necessary. An authorized officer of the nonprofit organization must complete your application. If you have any questions, please email .

Application Attachments and Supporting Documentation

Copy of your organization’s IRS 501(c)(3) notification letter

Current list of board members and affiliations

Most recent audited financial statement, if available

Current IRS Form 990

Informational brochure, if available

Organization Contact Information

1.  / Organization contact and title:
2.  / Complete mailing address:
3.  / Location address (if different):
4.  / Contact telephone number:
5.  / Contact email address:
6.  / Organization website:

Signature of Authorized Officer

As an authorized officer of the nonprofit organization requesting funding, I attest that all information provided in this grant application and any included supporting documentation is true and accurate. If a grant is awarded, I agree that the funds will be used solely for the purposes described in this proposal. I understand that any changes to our use of awarded grant funding must be approved in writing by the Opus Community Foundation prior to use.

Signature of authorized officer:
Authorized officer name and title:

Grant Purpose

Does your application fall within one of the Opus Community Foundation funding focus areas listed below?

Yes No

If yes, please check the focus area(s) most closely associated with this grant:

Funding Focus Areas
Affordable housing
Afterschool mentoring and tutoring
Arts/music education and access for youth and/or
LMI communities
Community health
Domestic violence prevention and child safety / Early childhood development/school readiness
Education
Financial literacy education
Safety net services
Workforce development/job skills training
Other:

Organization Overview

Please provide your organization’s mission statement.

Please provide a brief summary of your organization’s history, purpose and key initiatives.

Specific Request

How will these funds be used? Please include details about the specific program or project these funds will support.

Organization Accomplishments

Provide a brief summary of your organization’s current or intended accomplishments as related to this grant request.

Demographics

What age group(s) and client characteristics will be served by the project for which you are requesting funding?

Pre-K
Grades K-5
Grades 6-12
College / Adult
Elderly
All / Low Income*
Moderate Income*
Middle Income
Upper Income

*If this project serves LMI persons or communities, please indicate the percentage of clients served that are LMI individuals.

Area Served

What geographic areas will be served by this project or program? Please be specific in how far it extends throughout a given area, such as city, state, and/or region. If there are any Opus Bank offices in your service area, please note the closest banking office location(s).

Timeline

What is the proposed start date and duration of the project for which you are requesting funding?

Project/Program Budget

What is the proposed budget of the project/program for which you are requesting funding? Attach as a separate sheet if necessary. Please include both income/funding sources and project/program expenses.

Top Funders

List your organization’s top 3-5 current business contributors and foundation grants, including levels of support.

Opus Bank Employee Involvement

Do any Opus Bank employees volunteer for your organization? If so, please provide names and roles or responsibilities.

Grant Performance

How will you evaluate the success of this project/program?

Will the organization provide a grant performance report, highlights and/or updates on how the funds were used?

Yes No

Opus Community Foundation

How did you hear about this grant opportunity?

Has your organization received a grant from the Opus Community Foundation in the past? If so, please list year(s), amount(s) and project/program funded (if applicable).

Additional Comments or Special Features

Submission Instructions

Thank you for completing this application. We look forward to receiving your request. Please mail and/or email all materials to:

Katie S. Ellis

Executive Director

Opus Community Foundation

19900 MacArthur Blvd., 12th Floor

Irvine, CA 92612

Email:

We accept applications on a rolling basis throughout the year. Please note that in order to evaluate applications thoroughly, our review process can take up to four months.

Form 2014 Grant Request / 1 / 10/19/2016