COUNTY TAYLOR ENDOWMENT FOUNDATION 2009 GRANT APPLICATION
The Taylor County Endowment Foundation makes grants available to IRS 501(c)(3) `tax exempt' organizations and 170(b) `unit of government' organizations to assist the unmet needs with projects of educational, health, cultural, civic and charitable purposes for the benefit of the residents of Taylor county, Iowa. Grant amounts are dependent upon the allocation of funds available to the Foundation each fiscal year. Grant requests require equal matching funds, which must be documented. The maximum grant amount this year will be $7500.00. Please submit twelve completed applications by mail to the Taylor County Endowment Foundation, ATTN: Beverly Kinker, 3131 Adams Taylor St., Lenox, IA 50851 or delivered to Beverly Kinker at Iowa State Savings Bank, Lenox, Iowa. You may also deliver your completed application forms to Glenda Stockwell at 407 Central Ave., Bedford, IA. Questions may be directed to Beverly Kinker at 641-333-2867, any foundation member or by emailing [e-mail]. Grant Application Deadline is March 27, 2009. Applicants will be notified by the last week in April. ITEMS IMPORTANT FOR ALL APPLICANTS No handwritten applications will be accepted. Submit 12 copies of the application Do not put the applications in binders, notebooks or other presentation packages Complete all sections of the application and secure proper signatures A signed "Letter of Intent" to act as fiscal agent if your organization does not have a 5013 or 170b status
This grant proposal is available at http://www.extension.iastate.edu/taylor
Taylor County Endowment Foundation
Date of Application: ________________ Project Name: _____________________ Application submitted to: _______________
Organization Information
Name of Organization Legal Name (as listed with IRS)
Organization Address (city, state, zip)
Employer Identification Number
Phone
Fax
Website
Name of Contact Person
Phone
Email
Type of funding sought (circle one): Project focus area: (circle all that apply)
Youth Development Education
Capital Support
Special Project
Community Betterment Recreation & Environment Yes
Health & Human Services Arts & Culture No No ____________
EIN Number
Is your organization an IRS 501 (3) not for profit?
If no, is your organization a 170 b unit of government? Yes If no, you must have a fiscal agent. Please list name, address, phone and agent's EIN Number:
Fiscal Agent Address Phone
Tell us about your organization, any significant changes in activities and your major accomplishments. (4-5 sentences)
2
Describe the proposed project, including the goals and objectives. Discuss the community need for the project, the benefits for the community as a result of the project, and the community support for the project. Project goal:
Objectives:
Community Need:
Benefits:
Support:
Population served (estimated #): __________ Total Project Cost: $___________ Total requested from the Community Foundation: $___________
3
Outline other resources or partners identified to assist with the project; other funding secured, applied for and proposed for the project.
Indicate desired impact and how you will measure and evaluate the of results the project. Be specific regarding community needs/issues your project will address.
When will this project start and end?
Attachments In order to be considered for funding, your application MUST include the following items: Copy of latest Federal IRS Tax exempt status letter List of Board of Directors and their affiliations Copy of most recent CPA audit, financial statement or tax return (IRS 990 form) Only 1 copy needed Signed `Letter of Intent' to act as a fiscal agent only if you are not 501(c)3 or 170b status Signed Applicant Board Approval Agreement (see below)
Board Approval from Applicant Organization: We approve submission of this grant request and certify that the purpose of this request is charitable and that monies received from the Community Foundation will be used solely for the project stated in this application.
Board Chairman Date
4
Project Balance Sheet
Budget is for period _____________________ to __________________________.
Income
Sources
Endowment Grant
Expenditures
Amount
$ __________________
Items
__________________ __________________ __________________ __________________ __________________ __________________
Amount
$ __________________ $ __________________ $ __________________ $ __________________ $ __________________ $ __________________ *$ __________________
Fundraising _______________ $ __________________ Funds on Hand $ __________________
Other grants _______________ $ __________________ _________________________ $ __________________ _________________________ $ __________________ *TOTAL $ __________________
*These two totals must be the same.
Taylor County Endowment Foundation
Organization Balance Sheet
Assets Cash Securities Real Estate Other (specify) _____________________ _____________________ _____________________ TOTAL ASSETS $ __________________ $ __________________ $ __________________ $ __________________ $ __________________ $ __________________ $ ___________...