Site Visit Report – Jeffrey P. Ossen Family Foundation

New Grant Application

Legal Name of Organization*
Address of Organization*
Street Address Address Line 2 City State ZIP Code
Federal Tax ID #**
CEO/Executive Director*
First Last Title
Email*
Phone*
Is the main contact person the CEO/Executive Director?*
- Yes
- No
Main Contact Person*
First Last Title
Main Contact Person's Email*
Main Contact Person's Phone*
Principal purpose and services of your organization
Geographic Area(s) Covered*
Number of individuals served annually by your organization*
Number of full-time employees*
Number of part-time employees*
Specific purpose for which funds are requested
Is this a new program/project?*
- Yes
- No
Amount Requested*
Period of time in which funds will be spent*
Please include start date and end date
Additional Information
Organization's total budget*
Project/Program budget*
Organization’s fiscal year*
Grant Proposal Narrative
Organizational Information:
a. Brief Statement of Organization's history, mission and goals.*
b. Brief description of current programs, activities, accomplishments*
c. Population the agency benefits: socio-economic status; language; age; physical abilities and/or other descriptions, as appropriate; and how your agency involves them in its planning process.*
d. How this agency uses volunteers*
e. How this agency works with others that provide similar services, and how it is unique.*
Governance*
Please provide a description of the Board of Directors activities, including how often it meets; does the full board or a committee meet with the auditor; what financial information is given to the board on a regular basis, and how often.
Purpose of this grant:
a. Please provide a statement of the community need/issues to be addressed and describe the target population who will benefit.*
b. Project description including objectives, activities, timeframe, number served and frequency.*
c. Please state the top three outcomes you expect to achieve and how you will evaluate the program/project success in attaining them.*
d. Who are the key individuals involved in the project?*
Please provide brief summaries of their qualifications (no resumes, please).
e. What are the long-term strategies for funding this project beyond the grant period?*
Budget/Financial Information
Organizational and project budgets should include financial information for the most recently completed fiscal year, the current fiscal year, and projections for next fiscal year, aligned side by side.
Please attach the following items:
- Project budget including anticipated income and projected expenditures.
- Organization’s annual operating budget.
- Most recent audited financial statement or annual review.
Number of files you will be attaching*
File 1*
Accepted file types: jpg, gif, png, pdf, doc, docx, xls, xlsx, ppt, pptx, Max. file size: 2 MB.
File 2*
Accepted file types: jpg, gif, png, pdf, doc, docx, xls, xlsx, ppt, pptx, Max. file size: 2 MB.
File 3*
Accepted file types: jpg, gif, png, pdf, doc, docx, xls, xlsx, ppt, pptx, Max. file size: 2 MB.
File 4*
Accepted file types: jpg, gif, png, pdf, doc, docx, xls, xlsx, ppt, pptx, Max. file size: 2 MB.
File 5*
Accepted file types: jpg, gif, png, pdf, doc, docx, xls, xlsx, ppt, pptx, Max. file size: 2 MB.
File 6*
Accepted file types: jpg, gif, png, pdf, doc, docx, xls, xlsx, ppt, pptx, Max. file size: 2 MB.
Required Supporting Materials
Board of Directors List with affiliations and occupations.*
Copy of IRS 501 © (3) Determination Letter*
Accepted file types: jpg, gif, png, pdf, doc, docx, xls, xlsx, ppt, pptx, Max. file size: 2 MB.
Optional Supporting Materials
Organizational Chart
Accepted file types: jpg, gif, png, pdf, doc, docx, xls, xlsx, ppt, pptx, Max. file size: 2 MB.
Annual Report
Accepted file types: jpg, gif, png, pdf, doc, docx, xls, xlsx, ppt, pptx, Max. file size: 2 MB.
Letters of Agreement for Collaborative Proposals
Accepted file types: jpg, gif, png, pdf, doc, docx, xls, xlsx, ppt, pptx, Max. file size: 2 MB.
Include:
Name/Title
Date Completed

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New Grant Application

Principal purpose and services of your organization

Specific purpose for which funds are requested

Additional Information

Grant Proposal Narrative

Budget/Financial Information

Required Supporting Materials

Optional Supporting Materials