Burlington Livable Community Project

							            Burlington Livable Community Project
     Grassroots Community Action Sponsorship Application

DATE:                        CONTACT PERSON:


NAME OF APPLICANT ORGANIZATION:

ADDRESS:

PRIMARY PHONE:                              ALTERNATIVE PHONE:

EMAIL:

AMOUNT OF THIS REQUEST:

TOTAL PROJECT BUDGET:

TOTAL CURRENT ORGANIZATIONAL BUDGET:

TOTAL AMOUNT YOUR ORGANIZATION SPENT LAST YEAR:

NUMBER OF EMPLOYEES, FULL AND/OR PART TIME:

PROJECT PROPOSAL SUMMARY:

HOW DID YOU HEAR ABOUT THE BLCP COMMUNITY ACTION
SPONSORSHIPS?

IS YOUR ORGANIZATION (CHECK THE ONE THAT BEST APPLIES):

       ______ AN AD HOC GROUP
       ______ AD HOC GROUP WITH A FISCAL AGENT
       ______ INCORPORATED AS A NON-PROFIT IN YOUR STATE
       ______ 501(C)(3)
       ______ NEIGHBORHOOD PLANNING ASSEMBLY
       ______ OTHER (PLEASE DESCRIBE)

If you are an ad hoc group and do not have a checking account or fiscal agent, you will
need to set up an account or agent upon receipt of the sponsorship. You do NOT need to
have an account or agent when you apply.
PROJECT NARRATIVE AND BUDGET (no more than 2 pages):
  1. Give a brief description of your proposed project. Please include the following
     information: background on your group and the issue; mission or goal of the
     group; project plan; timeline with steps for completion of the project.
  2. If your project is successful, what changes will occur in your community and how
     will it contribute to priorities outlined in the Burlington Livable Community
     Project report?
  3. Provide a brief description of the potential to develop new citizen advocates or
     develop leadership skills among project participants.
  4. Project budget
         a. Itemize anticipated expenses and income for this proposal. Include in-kind
              services such as donated materials and/or labor.
         b. Please specify what expenses will be covered by the Sponsorship.
         c. Does your group have existing sources of support? If so, please list grants
              or other sources of income (membership dues, event revenue, individual
              donations, etc.)

APPLICANT PROFILE
  1. How long has your group been in existence?
  2. Who started the group?
  3. Has this group been involved in other issues? If yes, briefly describe.
  4. How many people are currently involved in the group?
  5. Please describe your decision-making structure. If you have a steering committee
      or other similar leadership structure, please provide the names and contact
      information for the members.
  6. Is this a membership organization? If yes, how much are paying member dues?
  7. Beyond your existing group, approximately how many people in the community
      can be “activated” to support your issue (ie. go to a meeting, sign a petition, call a
      council member)?
  8. Are any members of your group elected officials?
  9. How have you gained knowledge about your issue?
  10. If you have worked on other issues, describe your successes and challenges.
  11. What skills do group members currently have that will help you achieve your
      goals (ie. public relations, fundraising, community organizing, graphic design)?
  12. What skills do you feel you and/or your group could use to help move your issue
      forward?

In order to be considered for a sponsorship, complete applications must be submitted
electronically to Jennifer Wallace-Brodeur at jwbrodeur@aarp.org by 4:30 p.m. on
Friday, August 17, 2012.