Request Grant - Sylvia Perkin Perpetual

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Grant Request

Amount:

Project Title:

Type of Support:

Project Budget:

Term in Months:

Start Date:

End Date:

Describe the specific purpose for which any grant funds awarded from this foundation will be used:

Describe how a grant to your organization would further the foundation’s mission and the priorities of the foundation.

Describe the objectives of the project or program to be funded:

Describe the implementation plan for the project or program. Include at least three specific actions your organization will take in order to achieve results:

What criteria does (or will) your organization use to measure the success of the project or program?

Briefly describe any formal or informal collaborative ventures your organization has established (or will establish) with other entities serving similar purposes that may be relevant to this grant request.

If this grant relates to an ongoing project or program, how long has the project or program been operating?

Provide any other relevant dates relating to the project or program for which grant funds would be used.

Provide a concise budget for the project listing major expense categories.

List other sources that may fund this project.

Grant Demographics

Program Area:

Location:

Population:

Age Group:

Ethnicity:

Gender:

Demographics Comments:

Organization Background

Tax EIN:

Legal Name:

Tax Notes:

Entity Type:

Fiscal Agent Or Sponsor?

Physical Address:

Briefly summarize your organization’s current mission.

Board Members:

Number Of Paid Staff, Full-Time:

Number Of Paid Staff, Part-Time:

Number Of Volunteers:

Organization Finances

Organization Annual Budget:

Budget Changes:

What Percentage of Your Budget is Allocated to Administrative Expenses?

For Fiscal Year Ending:

If Your Organization Did Not File a Tax Return for its Prior Fiscal Year, Explain Why:

Contributions and Grants:

Program Service Revenue:

Investment Income:

Other Revenue:

Total Revenue:

Program Services:

Administration:

Fundraising:

Other Expenses:

Total Expenses:

Revenue Less Expenses:

Total Assets:

Total Liabilities:

Net Assets or Fund Balances: