Applications must be submitted electronically by 5: 00 p m. on September 30, 2017 Grant is a maximum of $25,000



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Major Grant Application

­­­­


Story County Community Foundation

P.O. Box 1666

Ames, IA 50010-1666
Applications must be submitted electronically

by 5:00 p.m. on September 30, 2017

Grant is a maximum of $25,000


Part I--Organization Overview
Applying organization:      

Contact person:      

Position in organization:      

Applying agency address:      

City, State, Zip:      

Phone number:      

Email:      



Type of applying organization:  501(c)(3) non-profit organization

 local government: type      



Brief description of organization:      

Federal tax identification number of organization:      
Fiscal sponsor information is only needed if different than the applying organization.

Name of fiscal sponsor (if different than applying organization):      

Federal tax identification number of fiscal sponsor:      

See end of application for fiscal sponsor agreement and signature.


Part II--Project Overview
Project name:      

Amount requested from SCCF: $      

Total cost of project: $      

Estimated number of Story County residents who will be impacted by this project:      

Brief description of project including how the SCCF funds fit into the project (in 200 words or less):      

Type of request (check one):  Capital-based or  Program-based

Program-based: Operational, activity, general programmatic support
Capital-based: The building of or physical improvement of something
Project focus area (check one):
 Arts/Culture/Humanities  Education  Environment/Animals  Health

 Human Services  Community/Public/Society Benefit  Other




Part III--Project Narrative Projects should be completed by August 31, 2018


  1. Describe the need or problem being addressed by this project and the population to be served:      

  2. Describe the project goals, objectives and projected results. Describe the steps you will follow to achieve goals and objectives, complete with timeline:      

  3. Will this project have long-term impact? How will this project be sustained?      

  4. Will you be collaborating with other community partners on this project? If yes, include partner letters of commitment to this project.      



Part IV--Budget Detail (for project only)

Attach any project quotes or other pertinent budget information. Do not include your organization’s budget for other projects.

.


Matching funds, if applicable to your project, are funds that will be contributed only if an equal amount of money is obtained from another source, such as SCCF.




Major Budget Items

Cost

In-Kind Funding (name)

Matching Funds

SCCF Funding Request

Example: wheel chair

$900




$300

$600

     

     

     




     

     

     

     




     

     

     

     




     

     


     

     




     

     

     

     




     

     

     

     




     

TOTAL

     




TOTAL

     


Funding Sources

Secured: Example: $300 match from XYZ Foundation      


Applied for:      


Other relevant information about potential funding sources:      



Part V—Consideration for a Community Grant
If this application is not chosen to receive a Major Grant would you like your project to be considered for a Community Grant of up to $6,000?  Yes  No

If yes, please answer the following:


  1. Amount that would be requested from SCCF: $       ($6,000 maximum)


  2. What portion of the project would you request funding for? Give details specific to only this portion of the project:      

  3. Budget detail for Community Grant consideration.




Major Budget Items

Cost

In-Kind Funding (name)

Matching Funds

SCCF Funding Request

Example: wheel chair

$900




$300

$600

     

     

     




     

     

     

     




     

     

     

     




     

     

     

     





     

     

     

     




     

     

     

     




     

TOTAL

     




TOTAL

     


Funding Sources

Secured: Example: $300 match from XYZ Foundation      


Applied for:      


Other relevant information about potential funding sources:      





Part VI--Application Submission
Please include:

  • a copy of current IRS Exemption Letter for the 501(c)(3) status of the Internal Revenue code (or that of the fiscal sponsor) or documentation of status as a charitable project of a governmental agency

  • the grant application form
  • list of the organization’s Board of Directors with contact information and email addresses


  • letters of commitment from partners collaborating on this project

  • letters of support are not required, but often can make a powerful statement regarding need


Please submit the above documents electronically (submit one PDF format file if possible) to storycounty@storycountyfoundation.org.

The project representative certifies that he/she is authorized to represent the organization applying for a grant and that the information contained in the application is accurate. He/she agrees that if a grant is awarded to the organization:


  • the grant will be used for the purpose outlined in the grant award letter and may not be expended for any other purpose without prior written approval from the Story County Community Foundation

  • the Story County Community Foundation has received nothing of material value in exchange for the grant

  • information about the organization and the grant may be used by the SCCF in any published materials

______________­­­­­­­­­­­­­­­­­­­­­­­­­­­­__________________________________ ___________________________



Authorized Project Representative Date
Printed name:      

Fiscal Sponsorship Agreement (to be filled out by Fiscal Sponsor only if you are using one)

Fiscal sponsor (Legal applicant):      

Name of fiscal sponsor contact:      

Fiscal agency address:      

City, State, Zip:      

Phone number:      

Email:      


     

Project name:      
(Legal Applicant/Fiscal Sponsor, hereafter referred to as The Sponsor) has agreed to serve as a fiscal/program sponsor for the       (Organization conducting project, hereafter referred to as the .) as outlined in the attached application and supporting materials. The Board of Directors of The Sponsor has passed a resolution adopting the ’s project as a program or project consistent with the Sponsor’s purpose and mission. The Sponsored Org.’s financial activities will be accounted for as a program of The Sponsor for IRS auditing and financial reporting purposes.
Since the Sponsored Org. is not recognized by the IRS as a charitable tax-exempt entity, The Sponsor must exercise full control over the Sponsored Org.’s financial administration, management and disbursement of funds resulting from this grant application. The Sponsor has delegated       (name of person/s) as responsible for fulfilling of these accounting and reporting functions subject to the ultimate authority of the Board of Directors of The Sponsor. The Sponsor is responsible for ensuring completion of timely reports and submission of necessary financial statements to the Community Foundation’s Administrative Office (contact info below). Failure to insure timely reporting on behalf of the Sponsored Org./Sponsor will also result in a loss of good standing.

This agreement will be in effect from the date of a grant award to support the above-named project until the grant funds are expended and the final report has been submitted and accepted.

We agree to the terms stated above in this agreement:

______________­­­­­­­­­­­­­­­­­­­­­­­­­­­­________________________________________ _____________________



Legal Applicant/Fiscal Sponsor Representative Signature Date

Printed Name:      


______________­­­­­­­­­­­­­­­­­­­­­­­­­­­­________________________________________ _____________________

Sponsored Organization Representative Signature Date

Printed Name:      



*Attach to this agreement the Fiscal Sponsor’s 501(c)(3) Tax-Exempt Determination Letter or comparable proof of charitable exemption. (i.e. a letter from a City, confirming their status as a government entity. Contact our Administrative Office with questions, or for examples of a letter from a City.)*

Story County Community Foundation http://www.storycountyfoundation.org/ Page


: documents -> filelibrary
filelibrary -> Agency : Central Iowa rsvp (Retired and Senior Volunteer Program) November, 2013 liaisons: John Linch and Dave Morris
filelibrary -> Contribution to Story County Community Foundation and/or our Family of Funds
filelibrary -> July 1, 2011 – Partnership of Iowa Foster Care Youth Councils
filelibrary -> Empathy Lesson: We Don’t Always Feel the Same Grade-k personal/Social Domain Standard A
filelibrary -> Davenport Community School District Counseling Program Empathy Lesson: Torn Heart Grade-1 Personal/Social Domain Standard A
filelibrary -> Problem Solving Lesson: Finding Out What Others Want Grade: k personal/Social Domain Standard A
filelibrary -> Phonological awareness ideas
filelibrary -> Personal/Social Domain: Standard B: Students will make decisions, set goals, and take necessary action to achieve goals
filelibrary -> Contribution to Story County Community Foundation and/or our Family of Funds
filelibrary -> Story County Decategorization Board Meeting Minutes for August 8, 2008 (1: 00- 3: 00 p m.) Story County Human Services Building 2nd Floor Conference Room (126 S. Kellogg, Ames, ia) Present




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