Rapid Response Fund Grant Application Form

Foundation for Louisiana’s Rapid Response Grant Application Form is designed to provide an easy way for organizations to access funds quickly in response to emergencies or disasters. If you need help completing the application please contact us at (225) 383-1672so that one of our staff may assist you. Email your application to .

Date of Submission:
Grant Amount Requested:

TO BE COMPLETED BY THE FOUNDATION

Disaster/Event Information
Date(s) of Disaster/Event:Fatal shooting of Alton Sterling on July 6th and ongoing protests/organizing and shooting of several police officers (3 fatal, 3 wounded) on July 17th 2016.
Type of Disaster:Police-involved shooting
City/State:Baton Rouge, Louisiana

TO BE COMPLETED BY APPLICANT

Organization Information
Grant Applicant Organization (if applicable):
Address:
Website:
Are you a 501(c)(3)? [ ] Yes [ ] No
If YES, provide your EIN number? ______
If NO, do you have a fiscal sponsor?[ ] Yes [ ] No
Name of Fiscal Sponsor:
Primary Organization Contact Person and Title:
Primary Organization Contact Telephone:
Primary Organization Contact Email:
Executive Director/CEO/President (or Fiscal Sponsor):
Telephone:
Email:
Number of Employees as an FTE:
Total Number of Volunteers:
What is the mission statement of your organization:
Are you a national organization (or local affiliate of a national organization)?: [ ] Yes [ ] No

The goal of the fund is to get funding and support into the community quickly but it is also necessary to make informed decisions. Provide as much information as needed to give an understanding of the services that will be provided and financial needs. Please see guidelines for more information about the kinds of activities and services that can be funded through the Rapid Response Fund.

Project Activities and Services
What is your connection to the community you are serving? (select all that apply)
[ ] Based in this area [ ] Involvement of leaders from local community
[ ] Clients are based in this area [ ] Mission to serve a specific neighborhood
[ ] City/State-wide organization [ ] Previous work in this neighborhood
[ ] Other (please elaborate)
Briefly describe the services/activities you will be providing (select all that apply):
[ ] Bas physical (repairs, replacing loss items)
[ ]emotional (providing counselling, spiritual support, healing)
[ ]planning (developing a community plan or conducting a needs assessment)
[ ]prevention (providing activities, training and education that can reduce risk for future activities)
[ ]direct service (providing sheltering, feeding, bulk item distribution)
[ ]financial (giving money to address specific needs including bail or tickets)
[ ]legal (providing information about legal rights, providing lawyers, monitoring a volatile situation)
[ ] advocacy (providing non-partisan information about key issues, organizing around policy changes)
[ ] Other (please elaborate)
Describe the steps for how the service/activity will be provided:
Where will this project be provided:
What is the time period for this project?:
How many people do you plan to serve with this project?:
How does this grant help your organization fulfill its mission to this community?:
Why is this program important to the recovery of this community?:
Do you have partners in providing this service/activity? If yes, please list and explain their role:
Anticipated Impact of Service to Be Provided
List three things you will deliver or supply as a resultof this project:
1.
2.
3.
List one outcome you hope to achieve:
How will you know if this effort has been successful?
Financial Information
Total Project Budget:
Salaries/Wages:
Travel Expenses:
Material/Equipment expenses (please list):
Other Expenses:
Contributions from others (please list and identify as either projected, pending or committed ):
Amount requested from FFL Rapid Response Fund:

EMAIL YOUR APPLICATION TO:

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