GRANT APPLICATION

Section One: Cover Sheet Information

Organization Information

Name of organization / Date of Submission
Address / City, State, Zip
Phone / Web site
Grant Writer / Phone / E-mail
Grant Director / Title / Phone / E-mail
Title of project / Projected number of unduplicated people to be reached in Union County.

Proposal Information

Please give a 2-3 sentence summary of request:

Budget

Dollar amount requested: / $
Total project budget: / $

Authorization

With my signature below, I do hereby certify that I have read, understand and support the application for SHARE

Foundation grant funding:

Name of Executive Director
Signature
Name of Board Chairperson
Signature

Section Two: Grant Description and Methodology(Please limit this section totwo pages)

1. Describe theproposed grant in one page.

2. Liststrategies and measurement toolsyou will use and the outcome(s) you will strive to achieve for

thisproposedgrant.

Example: Strategy: Conduct a coordinated approach to increase number of neighborhood watches

Measurement tool #1: Number of presentations, number of participants, number of new watch programs

Outcome:Increase and maintain number of neighborhood watches in Ward 1

3. List the sequence of stepsyou plan to carry out to achieve yourstrategies and outcomes during this

grant period.

Examples:

  1. Recruit Aldermen/councilmen to assist in each Ward
  2. Recruit residents to assist in each Ward
  3. Target high crime neighborhoods to implement active neighborhood watch programs
  4. Work with police departments to assist in development of each watch program

4. As preference will be given to collaborative efforts, with whom and how will your organization

collaborate on this particular request?

Letters ofcollaboration are encouraged but not required.

From example above you might list the organizations below along with the collaboration effort:

City governments / Aldermen

Ward 1 residents

Media

Crime Stoppers

Section Three: Funding and Sustainability (Please limit this section to onepage)

1. If applicable please list:

A. Other anticipated revenuesources and the amount for this proposed grant

Example:ABC grant $5,000

XYZ Foundation $3,500

B. In-kind support for this proposed grant

Example:

Volunteers based on national volunteer data: 300 hrs x $15/hr = $4,500

Use of rental facility = $500

2. If this grant is expected to continue beyond the grant period, describe plans for ensuring continued

funding.

Example:

We plan to write grants to Arkansas Blue Cross, Winthrop Rockefeller Foundation and King

Foundation; or

We have made provisions to include this program in our annual operating budget after this

grant ends.

Section Four: Statement of Need (Please limit this section to one page)

1. State the area(s) of focusand priority to be addressed in this grant as outlined in the RFP Section 5.

Grant Application Process:

Example: Focus: Community Involvement

Priority: Neighborhood watches / clean neighborhoods

2. What is the targeted population to be served and how many do you anticipate serving

directly and/or indirectly with this proposed grant?

3. Briefly describe, using referenced data/statistics, the need for your proposed grant. If you use

national data please compare that information to state and or county data.

Section Five: Organization Background (Please limit this section toonepage)

Summarize your organization’s history and past effectiveness in the county related to crime and violence intervention and/or prevention.

Required Attachments

____ Grant Application

____ Itemized grant budget to include other funders and multiple years if applicable

____ List of Board of Directors and/or Advisory Council with related affiliation

____ Copy of the current annual operating budget for the organization

____ IRS determination letter indicating 501(c)(3) status and EIN number or

documentation that the organization is a public (governmental) agency

____ Most recent full audit report, Form 990, or year-to-date financial statementand

full previous year financial statement. These are listed in order of preference.

If the only financial document available is the financial statement then both must

be signed by the Board Chairperson to indicate they have been reviewed and

approved by the governing board.

____ Copy of the Strategic Plan if available

NOTE: This is the end of the Grant Application Form. Please make sure you have completed all questions in each section and that the correct scoring block for SHARE Foundation use is at the end of each section. Please save your work for future reference. Utilize the above checklist to assure all required attachments are included before submitting your grant request.