Applicant Organization – Seagraves Foundation

Organization Application

Applicant Name

Year organization incorporated:

Address (include street address if different)

EIN#:

Is the name above the same as it appears on the IRS Letter of Determination?

yes no

If not, please explain:

Chief Executive Name & Title:

Contact Name & Title:

Phone Number:

Fax Number:

Email: MUST BE PROVIDED

ORGANIZATIONAL DEMOGRAPHICS

Number of part time staff:

Number of volunteers:

Geographic Area

OPERATING BUDGET FOR FISCAL YEAR:

Organization Name

Fiscal Year, from:

Fiscal Year, to:

SOURCES OF INCOME

% Federal

% State

% County

% City

% Fees/Earned Income

% Individual Contributions

% United Way

% Workplace Campaigns
(NOT United Way)

% Corporate and/or Foundation Grants

% Special Events

% Memberships

% Other

Amount of this Request:

Funds Need By:

TIME FRAME IN WHICH FUNDS WILL BE USED:

Date From:

Date To:

Type of Support

IF FOR SUPPORT, PLEASE COMPLETE THE FOLLOWING FIELDS:

Project Name

Total Project Cost

Percent this request is of project total:

Project Type:

If other, please describe:

Who Will the Project Serve?

How Many will the Project Serve?

What Geographic Area will the Project Serve?

FOUNDATION REQUESTS
The foundation requests that you limit the length of your answers for the following questions to NO MORE than a total of four pages. OR fill out below.

Upload Project Document Here:

Applicant Organizational Background

Include organizational mission statement and purpose, organization qualifications, history of accomplishments, governance, area and population served, role or volunteers. (If this is a collaboration, describe the lead agency and it's relation to others involved.)

Applicant Organizational Background Answer

NEEDS STATEMENT

Identify the needs your agency, or this proposal will address. Acknowledge similar existing projects or agencies, if any, and explain how your agency or proposal differs, and what effort will be made to work cooperatively:

Needs Statement Answer:

PROPOSAL

1. How will your propsal address identified needs?
2. Projected goals, objectives, timeline, anticipated impact.
3. Expected role of volunteers.
4. Number and types of people who will benefit from your proposal.
5. How will you monitor your work and how will you measure success or effectiveness?
6. What are your other potential and actual sorces of support for this proposal? Where do you expect to find future support?

Proposal Answer:

APPROPRIATENESS TO FOUNDATION'S MISSION

Explain how your project or program furthers the goals of The Janice Seagraves Family Foundation:

Appropriateness to Foundation Answer:

ADDITIONAL INFORMATION

Please address anything else about your organization or project that you think is relevant to this proposal:

Additional Information Answer: