Site Visit ReportNew Grant Application Legal Name of Organization*Address of Organization* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Federal Tax ID #**CEO/Executive Director* First Last Title Email* Phone*Is the main contact person the CEO/Executive Director?*YesNoMain Contact Person* First Last Title Main Contact Person's Email* Main Contact Person's Phone*Principal purpose and services of your organizationGeographic 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 requestedIs this a new program/project?*YesNoAmount Requested*Period of time in which funds will be spent*Please include start date and end dateAdditional InformationOrganization's total budget*Project/Program budget*Organization’s fiscal year*Grant Proposal NarrativeOrganizational 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 InformationOrganizational 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.Please list funding sources (foundations, corporations, others) for each fiscal year. Include the amount requested and the status of your request with each funder for the current year, and for the period of this request.Organization’s annual operating budget.Most recent audited financial statement or annual review. Number of files you will be attaching*123456File 1*Accepted file types: jpg, gif, png, pdf, doc, docx, xls, xlsx, ppt, pptx.File 2*Accepted file types: jpg, gif, png, pdf, doc, docx, xls, xlsx, ppt, pptx.File 3*Accepted file types: jpg, gif, png, pdf, doc, docx, xls, xlsx, ppt, pptx.File 4*Accepted file types: jpg, gif, png, pdf, doc, docx, xls, xlsx, ppt, pptx.File 5*Accepted file types: jpg, gif, png, pdf, doc, docx, xls, xlsx, ppt, pptx.File 6*Accepted file types: jpg, gif, png, pdf, doc, docx, xls, xlsx, ppt, pptx.Required Supporting MaterialsBoard 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.Optional Supporting MaterialsOrganizational ChartAccepted file types: jpg, gif, png, pdf, doc, docx, xls, xlsx, ppt, pptx.Annual ReportAccepted file types: jpg, gif, png, pdf, doc, docx, xls, xlsx, ppt, pptx.Letters of Agreement for Collaborative ProposalsAccepted file types: jpg, gif, png, pdf, doc, docx, xls, xlsx, ppt, pptx.Include: Name/Title Date Completed Save and Continue Later – Please COPY the link shown and paste somewhere safe. You should get an email too, but your firewall may prevent receiving it.