Application

Date*

Name of Organization*

501(C)3 Tax Exempt Number*

United Way Agency*

Amount Requested*

Fiscal Year*

Address (City, State, Zip Code)*

Contact Person*

Title*

Email Address*

Phone Number*

Mission of the Organization*

Geographic Area Served*

Number of People Served*

Principal Staff Members (paid vs. volunteers)*

Please provide an explanation of, and the percentage of, your organization’s efforts to benefit low-to-moderate income individuals*

Your application must provide a statistically supported description of the specific need your organization seeks to address and your history of meeting that need. Describe how the grant you seek will be used, leveraged and its effects measured. Address the long-term financial viability of your organization, its future means of support in the community and coordination with other nonprofit or governmental entities. Please feel free to include other attachments of your choosing that contain information you feel is relevant to supporting your grant application. Provide a statistically supported description of the specific community need your organization seeks to address.*

Provide a history of your organization’s ability to meet this need*

Describe how the grant you see will be used, leveraged and its effects measured*

Address the long-term financial viability of your organization*

Describe the future means of support in the community for this request and any coordination with other non-profit or governmental entities*

List other attachments relevant to supporting your grant application

Attachment

Send a copy to yourself

First Federal Charitable Foundation Application