JCPC FOUNDATION GRANT APPLICATION

I)       COVER SHEET (Please use this format to create a one-page cover sheet)

Date of Application:  _________________ Year Organization Founded:  _____________

Organization Name:  ______________________________________________________

Address:  _______________________________________________________________

Telephone Number:  ______________________Fax Number: _____________________

E-Mail Address:__________________________________________________________

Organization web site:_____________________________________________________

Principal Officer:  ________________________________________________________

Contact Person & Title (if not Principal):  _____________________________________

Grant Request:  _____________________  Period Grant Will Cover:________________

Summarize the Organization’s Mission (2 to 3 sentences):  ___________________

________________________________________________________________________

Summary of Project or Grant Request (include goals and objectives):  _______________

________________________________________________________________________

II)    NARRATIVE (maximum of 3 pages)

a)         Briefly describe your organization’s current programs and activities

b)         Describe the goals and objectives of this request.


III)             ATTTACHMENTS  (Supply everything below)

a)                  Evaluation:  Briefly describe your plan for evaluating the success of the project..  How will the evaluation results be used?

b)         Organizational Structure/Administration

1.  Briefly describe how your organization works: 

2.  Who will be involved in carrying out the plans outlined in this request? 

c)         Finances

1.         Organization’s current annual operating budget. (See attached if needed)

2.         Current project budget (See attached if needed).

3.         List individually other funding sources for this request.  Include amounts and whether received, committed or projected/ pending.

4.         Describe your plans for future fund raising.

5.         A copy of your IRS 501 (c) (3) letter

Guidelines for Applicants

By US Postal:

Send 4 complete copies: cover sheet, proposal and attachments to the following address:

JCPC Foundation

P.O.Box 1507

Brookfield WI.  53008-1507

Binders or folders are accepted.

By e-mail: 

Send application and appropriate PDF files to:  contact@JCPCFoundation.org.

IV)  BUDGET

If you already prepare organizational and project budgets that approximate this format, please feel free to submit them in their original forms.  You may want to reproduce this form on your computer and /or submit separate pages for income and expenses.

Budget for the period:  _______________________ to:__________________________

 

Expenses

 

Income

Item

Amount

Source

Amount

Salaries & Wages

$

Government grants

$

Fringe Benefits & Payroll Taxes

 

Contracts

 

Consultants & Professional fees

 

Foundations

 

Travel

 

Corporations

 

Equipment

 

Religious Institutions

 

Supplies

 

United Way

 

Training

 

Federal Campaign

 

Printing & copying

 

Individual contributions

 

Telephone & fax

 

Membership Income

 

Postage & delivery

 

In- Kind support

 

Rent & utilities

 

Other ( earned income, consulting fees, etc.)

 

In- Kind expenses

 

 

 

Other

 

 

 

 

 

 

 

Total Expenses

 

Total Income

 

                                                                                                                                            Balance $______________________