Submit the Application by Email to
Instructions
A complete application will include all of the items in the checklist below. Item 1 is the Evaluation Chart; we recommend that you complete it first, then use this Microsoft Word document to complete item 2 in the checklist. Click here to return to the list of grants and download the chart from the appropriate grant page.
Submit the application by email to .
Melissa McC. Warlow, Executive Director, is available to answer your questions and provide guidance as you prepare your application. She can be reached at 410-332-4172, ext. 150 or .
I. CHECKLIST
Check one box for each item before submitting your application.E-mail / Mail / N/A
/ 1. Completed Evaluation Chart.
2. Proposal (Must be submitted as a Microsoft Word document)
I. Checklist
II. Contact Information
III. Proposal Narrative
IV. Financial and Board Information
3. Maryland Cultural Data Project-Baker Fund report. On the Maryland Cultural Data Project website, www.mdculturaldata.org, go to “Funder Reports” and submit the William G. Baker, Jr. Memorial Fund report.
4. Most recent compilation, review, or audit prepared by an independent public accounting firm with all notes, management letter, opinion letter and all other referenced documents.
5. Attach list of key organization personnel with titles.
6. Most recent IRS Form 990 with Schedule B, Part 1 (Schedule of Contributors) for the applicant or the fiscal sponsor. If not current, send most recently filed Form 990 and a copy of approved extension (Form 8868) filed with the IRS.
7. Most recent copy of the applicant or fiscal sponsor’s 501(c)(3) determination letter from the Internal Revenue Service.
8. (If you are using a fiscal sponsor) Letter from fiscal sponsor, signed by its executive director, indicating willingness to administer the grant if awarded and listing any fees charged for services provided by the fiscal sponsor to the grant seeker, if applicable.
Optional Attachments, maximum of two, e.g. brochure, most current newsletter.
II. CONTACT INFORMATION
APPLICANTName of the organization as recognized by the Internal Revenue Service:
Trade Name of the Organization (if applicable):
Street Address: City: State: Zip:
Phone: Fax: Email:
Website:
Name of chief executive: Title:
Phone: Fax: Email:
Does your organization have 501(c)(3) status from the Internal Revenue Service? / yes / no
(If your organization does not have tax-exempt status from the Internal Revenue Service
complete the Fiscal Sponsor section.)
Federal Tax ID/Employer Identification Number:
Has your organization previously applied for a grant from the William G. Baker, Jr. Memorial Fund? / yes / no
Has your organization received a grant from the William G. Baker, Jr. Memorial Fund? / yes / no
FISCAL SPONSOR (if applicable)
Name of the fiscal sponsor as recognized by the Internal Revenue Service:
Trade Name of the Organization (if applicable):
Street Address: City: State: Zip:
Phone: Fax: Email:
Website:
Name of chief executive: Title:
Phone: Fax: Email:
Federal Tax ID/Employer Identification Number:
REQUEST
Name of program or project:
Request Amount:
Name and Title of the Primary Contact Person for this Request:
Phone: Fax: Email:
III. PROPOSAL NARRATIVE
GRANT REQUEST SUMMARY
Summarize the purpose and amount of your request (100 words or less)
ANTICIPATED RESULTS
Copy your top three areas of impact and anticipated results from the Anticipated Results section of the completed
Evaluation Chart and list here:
1.
2.
3.
ORGANIZATIONAL BACKGROUND (250 words or less)
Describe your organization, the year it was founded, its history, mission, benefit to the community, past accomplishments, current activities, number of people served, and number of full and part-time staff.
PURPOSE OF THE REQUEST AND ANTICIPATED RESULTS (650 words or less)
Use this section to make your case. Be sure to provide the following information as it relates to the purpose of your request.
· Describe the purpose of your request and the needed addresses.
· For general operating support requests, describe how your organization assesses its overall success and effectiveness and how the request will enhance your organization’s capacity and sustainability.
· If your request is funded, what do you hope to accomplish in the short and the longer term.
· What other organizations or funding partners support or are likely to support this request? In-kind contributions should be noted here.
· Your narrative should support all expense items listed in your program/project budget.
TIMELINE AND RESOURCES
1. Start and end dates of the work described above: / Start / End2. Provide a timeline for the work described above.
3. What additional resources (fundraising, staffing, partners, etc.) need to be secured to start and sustain the work described above?
IV. FINANCIAL AND BOARD INFORMATION
FINANCIAL INFORMATION
1. Program or Project Budget Summary- Only for direct revenue and expenses specific to the program or project for which funds are being requested. In-kind contributions should be mentioned in Section III--Purpose of the Request. For core operation requests, move to the second item in this section—Organization’s Revenue and Expenses.
Double-click on the Program or Project Budget Summary worksheet below to enter it. Complete the blue areas. Enter a value of "0" where you do not have a figure. Click outside of the worksheet to exit it.
2. Organization’s Revenue and Expenses
Preferably in one table, paste below the current year budget’s revenue and expenses, and year-to-date actual figures; and the two most recent year-end budgets showing a comparison of actual to budget for each period. Explain all variances between this financial information and what is reported in Maryland Cultural Data Profile.
(Paste Here Organization’s Current Year Revenue and Expense Budget
and Year-to-Date Actual, and the Two Most Recent Year-End Budgets Compared to Actual)
3. Balance Sheet/Statement of Financial Position
Below paste the audited Balance Sheet/Statement of Financial Position (BS/SFP) for the end of the most recently completed fiscal year or if last year’s total revenue was too small to require an audit paste the Balance Sheet for the end of the most recently completed quarter.
Audited BS/SFP? ___ yes ___ no Month/ Day/Year of BS/SFP ______
4. Organization’s Foundation Support, Operating Reserve and Endowment
List the five largest sources of revenue from foundations budgeted for the current fiscal year.
Foundation Name / Amount / Status of FundingReceived, Committed, Applied, or To Be Requested
1
2
3
4
5
Provide clarifications or explanations of the financials:
How do you plan for building/equipment maintenance?
If you have an operating and/or working reserve, what are the current values? $
How frequently do you use these reserves and for what purposes?
If you have an endowment what is its current value? $
Summarize the restrictions and Board-approved policies for the endowment, operating, and/or working reserve funds:
(Paste Balance Sheet/Statement of Financial Position Here)
BOARD INFORMATION
1. List the name, board office title, and professional affiliation of current board members.
Name / Board officer title (if applicable) / Professional Affiliation2. Complete the chart below
Board Member Contributions / Current Fiscal Year / Prior Fiscal YearSupply dates: / (mm/yy – mm/yy) / (mm/yy – mm/yy)
Total number of board members
Number making financial contributions
Total board member contributions / $ / $
Page 2 of 6 Revised 07/18/2011