Grant Application

Applying Organization

Address

Website

Contact Person First Name

Contact Person Last Name

Contact Person Title

Phone

Mission Statement/Purpose of Organization

Grant Request Summary (1-3 sentences)

Project TImeline

Total amount requested from MCF $

Total cost of project $

Geographic Area Served

Estimated number of individuals served each year residing in the McLean Planning District:

Estimated total number of individuals served each year:

Number of paid staff

Number of volunteers

Total annual revenue/expenses

Fees charged for organization's services

Describe the proposed project, including the existing needs that will be addressed and the desired goals that will be achieved

Provide grant budget breakdown. Attach additional documentation if necessary (i.e. cost estimates or bids)

Additional documentation

Is any portion of this project receiving funding from other organizations? If yes, please identify the organization(s) and list their contribution.

Please supply a list of previous grants this organization has received from the MCF including the dollar amount, the purpose, and the date of the grant.

As a lawful representative for the applying organization, I affirm that I have read the MCF Grants Policy and to the best of my knowledge certify that this application is in compliance with the Policy.

As a lawful representative for the applying organization, I affirm that all the statements made in this application are, to the best of my knowledge, true.

Print Name and Title

Signature

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Date

Month

Day

Year

Attach Proof of organization's 501(c)(3) status

List of Board of Directors and Officers

Organization's most recent IRS Form 990

Organization's most recent Balance Sheet

Organization's most recent Income Statement

Deadlines: All applications must be received no later than April 1 for the Spring Grant Cycle and October 1 for the Fall Grant Cycle. While the application is pending, the applicant should notify MCF of any material changes in the information set forth in the application.