Grant Applicant Information

Contact Person

First

Last

Title

Name of organization

Phone

Contact Email

Purpose of Grant and Aniticipated Results

Amount of Grant Requested

Total Anticipated Project Cost

Organization's Annual Operating Budget

Does your organization have 501(c) status?

Yes
No

If yes, name of Non-Profit

Proof of IRS Non-Profit 501(c) Designation

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Provide Your latest Financial Documents

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(Balance Sheet, and or Income Statement)

Has the CCF granted funds to your organization in the past?

Yes
No

If yes, please provide a brief description including dates and dollar amounts

If and Narrative

I, (We), further certify that one year from the date of approval, a report will be provided to the CCF detailing the success and/or progress of the project/program.

Please sign below:

Signature

Clear Signature

Project Information

Organization Address

Address Line 1

Address Line 2

City

State

Zip Code

Organization Purpose

I can provide a list of board members and their affiliates, audited (if unavailable, submit unaudited) financials statements and quotes

Yes
Unaudited

Documentation of: Board members and their affiliates, financials statements AND quotes.

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File Upload

Administrative Expenses (Management and Overhead) as a Percentage of Total Expenses

Fundraising Expenses as a Percentage of Dollars Raised

Number of Paid Staff and Volunteers

Narrative Summary of the Project and Program

I plan to collaborate with other organizations

Yes
No

If yes, describe the plans with the other organizations

Number of people the project will benefit

Project timetable

Certification

I herby certify that...

As, the person identified above, I have been authorized by the organization’s board of directors to herby make an application to the Cortland Community Foundation for approval of the project described in the attached grant application and budget.

I agree to...

To provide the CCF with a report describing the results of the project, how the CCF funds were used and who benefited
The corporation/agency will abide by the decisions of the Cortland Community Foundation to the propriety of all expenditures for which the Foundation funds are requested
No person being denied the services or facilities of this project because of race, creed, color, or sex
Equal employment opportunities being provided to all qualified applicants for employment

Please select all to continue with your grant application. All these items are required to abide by.

Executive Director or President of the Board:

Name

First

Last

Phone

Email

Address

Address Line 1

Address Line 2

City

State

Zip Code

I agree, if selected as a recipient of a grant, I agree to provide the Foundation with a report describing the results of the project, how the Foundation’s funds were used AND who benefit

Signature

Clear Signature

Grant Application Over 1K

Grant Applicant Information

Purpose of Grant and Aniticipated Results

Project Information

Certification

Executive Director or President of the Board: