Grant Application Form
$Organization Name (and legal name if different) / Amount Requested* / Date
Federal Tax ID Number
*Grant requests up to $10,000 are accepted on a rolling basis throughout the year. Grant requests for amounts higher than $10,000 are considered at the discretion of the Board of Directors and are accepted by invitation only.
Please complete all fields and questions. Attach separate sheets as necessary. An authorized officer of the nonprofit organization must complete this 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
Current IRS Form 990
Most recent audited financial statement, if available
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 AreasAffordable housing
Afterschool mentoring and tutoring
Arts education 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
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-KGrades K-5
Grades 6-12
College / Adult
Elderly
All Ages / 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, or region. If there are any Opus Bank locations in your service area, please note them.
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? Include both income/funding sources as well as project/program expenses. Attach as a separate sheet if necessary.
Top Funders
List your organization’s top 3-5 current business contributors and foundation grants, including levels of support.
Opus Bank Team Member 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. Please email and/or mail all materials to:
Katie S. Ellis
Executive Director
Opus Community Foundation
19900 MacArthur Blvd., 12th Floor
Irvine, CA 92612
If you choose to mail your application, this page does NOT need to be printed or included.
We accept applications for requests up to $10,000 on a rolling basis throughout the year. Grant requests for amounts higher than $10,000 are considered at the discretion of the Board of Directors and are accepted by invitation only.
Please note that in order to evaluate applications thoroughly, our review process may take up to four months.
Once you have submitted your application, we ask that you wait at least one full calendar year before submitting a new grant proposal to the Foundation, regardless of the outcome of this request.
If you have any questions, please email .
Form 2015 Grant Request / 1 / 10/19/2016