National Greek Orthodox Ladies Philoptochos Society, Inc.
Grant Request Form
2013
This document seeks to explore your program, its history, track record andneeds.
Eligibility Requirements:
In order to be eligible for consideration, all applicant organizations MUST:
· Have current 501(c)(3) status from the Internal Revenue Service.
· Be located in or serve populations of the Greek Orthodox Archdiocese of America, which includes the 50 states of the United States and the Bahamas (Nassau).
· State clearly your project or program mission or intent and provide appropriate justification for funding.
Exclusions:The Project Review Committee of the National Ladies Philoptochos Board will not consider requests for:
· Direct grants, scholarships or loans for the benefit of specific individuals
· Projects of organizations whose policies or practices discriminate on the basis of race, ethnic origin, sex, creed or sexual orientation.
Part I: Organization Information
Name of Organization: ______
Mailing Address: ______
City: ______
State: ______Zip/Postal Code: ______
Phone Number: (_____) - ______
Fax Number: (_____) - ______
Website: ______
Fact Sheet:
Please attach a basic fact sheet so we can gain a better understanding of your organization.
Primary Contact: ______
Title: ______
Please provide mailing address if different from that of main organization listed above.
Primary Contact Office Phone Number: (____) - ______
Primary Contact Cell Phone Number: (____) - ______
Primary Contact Fax Number: (____) - ______
Primary Contact Email: ______
Letter of Recommendation:
If available, please attach a letter of recommendation from someone who has knowledge of your institution’s project, program or proposal who can advocate or vouch for you to receive funding.
Part II: Mission Statement (Statement of Purpose)
What is the mission of your organization?______
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How would you describe your current constituencies? ______
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Which geographical locations do you serve? ______
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Who currently serves on your organization’s board?
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Provide a brief history of your organization. ______
______
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Part III: Pertinent Statistics:
Total annual budget in the last completed fiscal year ______
______
Number of people your organization served last year
______
Number of full-time employees your organization employs ______
Is your organization a 501(c)(3) public charity?
Yes ____ No ____
If so, please provide your organization’s Employer Identification Number (EIN)?
______
Did your organization have an external financial audit conducted in the last fiscal year?
Yes ____ No ___
Annual Report:
If available, please submit a copy of your institution’s last annual report.
Grant Request Information
Project/Program Title:
______
Project Description:
Comprehensively describe the purpose of the project or program. Please tell us about any of its unique aspects or what makes it innovative.
What issues or needs will the National Philoptochos grant help your organization address or meet?
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What specific outcomes or deliverable do you plan to achieve with this project?
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How will the funds be used?
Please be as specific as possible. Will the funds be used to purchase badly needed equipment, to pay for the care or services for those individuals who cannot afford to pay (since they are under or uninsured), to start or support a necessary program, or to fund vital research?
______
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How many people (adults, children or families) do you estimate this project/program will serve? ______
How would you describe the specific constituency this grant is designed to affect?
______
What is the total estimated budget/annual cost of this specific project or program?
It is best for you to give us your request with the cost broken down so that we can consider meeting all or part of your needs.
______
What other grants have you received for this project or initiative?
Please provide us with an example of how your program has enhanced the life of an individual(s), or will enhance the life of an individual(s) if put into place.
Note: Please be sure to attach any collateral documents that you believe would support your application.
Please mail, email or fax this information to:
Helen Lavorata
Director, National Office
Greek Orthodox Ladies Philoptochos Society, Inc.
126 East 37th Street
New York, NY 10016
(email)
212-977-7770 (office phone) (eastern time)
212-977-7784 (office fax)
If you have any questions, please contact:
Arlene Siavelis
National Philoptochos 1st Vice President
Project Review Chairman
(email)
847-921-3208 (cell) (central time)