SUMMIT AREA PUBLIC FOUNDATION

GRANT APPLICATION
(Rev Jan 2015)

PLEASE READ THE GRANT GUIDELINES BEFORE COMPLETING THIS APPLICATION FORM. Grant proposals must be received by April 1 or October 1 to be considered
at the June or December Board of Trustees meetings.

Please submit your application electronically, in PDF format,
to .

Please limit PDF file size to 3MB.
For tips on reducing file size, see our Grant Guidelines.

Organization

Legal name

Address

City State NJ ZIP Federal tax ID#

Website URL

Program

In 50 words or less, describe the program for which you are seeking support, including information on the population served.

What is your organization’s overall purpose and relevance to the community?

Detailed description of program for which you are seeking support. This description should include detailed information on

·  the project and how it will operate

·  the population to be served and why they need the service being proposed

·  the projected outcome or results of the program and how the outcome will be evaluated.

Person responsible for program’s oversight and evaluation

Name Title

Address (if different from organization’s)

Phone Email

Population served

Total number of people served by the program

Number of Summit-area residents served by the program

Budget & other information

Please use the attached form to present a detailed budget.

How will you support this program in future years?

What is the proposed time frame for this program?

If your organization has received any grants from SAPF in the past five years, please describe them here:

Year / Amount / Description / Year / Amount / Description

Supplementary information (ONE copy of each, attached to original application)

Please attach the following items:

·  If you have received a grant from SAPF in the past two years, include a completed Program Evaluation Report for the most recent grant

·  Your organization’s current annual budget.

·  Your organization’s 501(c)(3) certification, including date of exemption granted by the IRS.

·  Most recent IRS Form 990 (Pages 1-9 only).

·  Most recent financial statement (audited, if required).

·  List of current officers and board members/trustees (with their affiliations).

Person submitting this application

Name Title

Address (if different from organization’s)

Phone Email

In submitting this application, I certify that the information I have provided is accurate and complete to the best of my knowledge and that I have full authorization to submit this application on behalf of the applicant organization.

/ By checking this box, I certify that this application was approved and authorized by the person whose name appears immediately above on mm/dd/yy.

Applicant Name SAPF Application

BUDGET for this PROJECT

PROJECT EXPENSES / Requested from SAPF in this application / REQUESTED from other sources (not yet approved) / AVAILABLE from other sources (approved) / TOTAL
PERSONNEL COSTS
Administrative
Other (Please specify)
Overhead/benefits
TOTAL PERSONNEL
OTHER COSTS
Supplies/consumables
(Please specify)
Contracted services
(Please specify)
Equipment
(Please specify)
Utilities
(Please specify)
Support/training
(Please specify)
Other costs
(Please specify)
TOTAL OTHER COSTS
TOTAL EXPENSES

PROJECT REVENUES Please identify each project revenue source and indicate whether the figure is projected or already approved.

Nature of funding / Projected / Approved / TOTAL
Agency’s cash on hand
Projected fundraising
Fees for services
Government funds
Grants (specify below)
(Identify source)
(Identify source)
(Identify source)
Other: (Identify source)
TOTAL REVENUES / (Must equal TOTAL EXPENSES, above.)