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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		 /
DD		 /
YYYY
 
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 *

###		 -
###		 -
####
 
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

MM		 /
DD		 /
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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