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
Describe the need or problem being addressed by this project and the population to be served:
Describe the project goals, objectives and projected results. Describe the steps you will follow to achieve goals and objectives, complete with timeline:
Will this project have long-term impact? How will this project be sustained?
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.
Please submit the above documents electronically (submit one PDF format file if possible) to firstname.lastname@example.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:
Sponsored organization conducting project:
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 Sponsored Org.) as outlined in the attached application and supporting materials. The Board of Directors of The Sponsor has passed a resolution adopting the Sponsored Org.’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:
Sponsored Organization Representative Signature Date
*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