Grant Application

M&M Area Community Foundation Grant Application
1.1 Please select the type of grant for which you are applying. *
Community Wide
Derusha AODA
Health
Peshtigo Area Foundation
Women’s Giving Circle
Youth Advisory Committee
The Derusha AODA Deadline is Wednesday, July 17th. Call our offices at 906 864 3599 for additional information.
1.2 Today’s Date *

MM

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1.3 Name of Organization *

1.4 Executive Director *

1.5 Principal Mailing Address *
Street Address *

Address Line 2

City *

State / Province / Region *

Postal / Zip Code *

Country *

1.6 Phone *

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1.7 Email *

1.8 Contact Person For Project *

1.9 Project Name *

1.10 Purpose of Grant *

Please limit description to 100 words or less.
1.11 Project Start Date

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YYYY
Leave blank only if project is ongoing
1.12 Funds Requested *
$

Dollars
 .

Cents
Cents are not required. Please round up to nearest dollar.
1.13 Board Chair or President *
Prefix

First *

Last *

Suffix

2.1 Is your organization a previous grant recipient? *
Yes
No
If no, move on to question 3.1
2.2 Year and Amount Funded

2.3 Project Name

2.4 Was publicity provided to acknowledge the grant?
Yes
No
2.5 Brief Summary of Project

Please limit to less than 300 words.
3.1 Project Name *

Should match question 1.9
3.2 Purpose of grant *

Should match question 1.10
3.3 Start and end dates of project

Leave blank if project is ongoing
3.4 Geographic Area Served *
Amberg Area
Athelstaine Area
Coleman Area
Crivitz Area
Daggett Area
Marinette Area
Menominee Area
Niagara Area
Pembine Area
Peshtigo Area
Pound Area
Powers Area
Stephenson Area
Wausaukee Area
Click all that apply. Multiples are possible.
3.5 Total Project Cost *
$

Dollars
 .

Cents
Cents are not required. Please round up to nearest dollar.
3.6 Amount Requested
$

Dollars
 .

Cents
Cents are not required. Please round up to nearest dollar.
3.7 Project Overview

Please include paragraphs for:1. Executive Summary

2. Describe project goals and objectives and how they will be measured

3. Is this a new or ongoing project? Describe.

4. Explain your plan to accomplish your goals and objectives for this project.

5. Are there other partners in this project? Explain.

6. If you are not granted full funding, you you have a contingency plan? Describe.
4.1 IRS form 990 *

Please attach most recent IRS form 990 (pages 1 and 2). If these forms are not available, please attach a letter of explanation.
4.2 Organization’s Fiscal Year *

Month / Year to Month / Year
4.3 Project Budget *

Please attach a document with budget information for the project in this order.1. Salaries

2. Payroll Taxes

3. Fringe Benefits

4. Consultants

5. Insurance

6. Travel

7. Equipment

8. Supplies

9. Printing & Copying

10. Telephone / Fax

11. Postage Delivery

12. Rent

13. Utilities

14. Maintenance

15. Evaluation

16. Marketing.

17. Other

18. Total Project Costs
4.4 Revenue

Include the total amount for each of the following budget categories, in this order, indicating which sources of revenue are committed and which are pending.Grants / Contracts / Contributions

1. Local Government

2. State Government

3. Federal Government

4. Foundations (Please itemize)

5. Corporations (Please itemize)

6. Individuals

7. Other (Specify)

Earned Income

8. Events

9. Publications & Products

10. Membership Income

11. In-Kind Support

12. Other (Specify)

13. Total Revenue

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