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Willie Nelson Concert Proceeds

VIEWS: 17 PAGES: 3

									                           Willie Nelson Concert Proceeds
                                GRANT APPLICATION
              Administered by the Red Lodge Area Community Foundation

Please answer all questions on pages 1-3 and submit one (1) copy to the Red Lodge
Area Community Foundation. Incomplete applications will not be considered. Please do
not include information that has not been requested. If additional information or
clarification is needed you will be contacted.

 1. Name of Organization***
 2. Mailing Address:
 3. City, State, Zip:
 4. Phone/Fax/Web Address:
 5. Contact Person & Title:
 6. E-mail (E-mail address is required):
   ***If your group is using a fiscal sponsor, the fiscal sponsor must be the applicant
   organization.
 7. Organizational budget (annual amount): $
 8. Type of Organization (Please check one of the following):
                 501(c)(3) Organization (IRS designation, not State of Montana designation)
                 Exempt Governmental Unit
                 Other
 9. Amount Requested: $
10. Total Project Cost: $
11. Project start date:       and Project completion date:
12. What population or area in Carbon County will the grant serve?
13. How much have you already raised for this project?
14. What portion of your annual budget is funded by charitable contributions and what other
    organizations or individuals have contributed or committed funds to this project?
15. Which other organizations have you applied or will apply to for this project?
16. Number of volunteer hours performed on behalf of your organization during current year:




                                            1
  17. Program Narrative. (Maximum of 2 pages + Budget and Budget narrative)

a. Project Description: In one sentence describe the project (i.e, Who is requesting the
   money to do what project for how much money in what timeframe and why).

b. Problem or Need Statement: Provide a clear, concise, well-supported statement of the
   problem or need that will be addressed by your proposal. How is this connected to the
   goals for the “Willie Concert Proceeds Grant” of enriching, enhancing or improving the
   lives of Carbon County children with special needs (i.e. mentally, emotionally,
   physically and/or socially)?

c. Goals & Objectives: Clearly describe the overall project goal and attendant objectives.
   Goals and objectives should be specific, measurable, realistic, and attainable.

d. Methods: Describe the activities that will be completed to achieve desired objectives
   and a proposed timeframe. (How/when will you do what you propose to do?)

e. Outcomes: What will be the results of your project and how do these outcomes relate
   to the goals of the grant guidelines?

f. Evaluation Plan: Define how success will be determined. What will you measure?
   What tools will you use to measure your outcomes? When will you measure, and what
   results will indicate success?

g. Sustainability: How will the project be continued after the grant funding is gone? What
   are the other sources of funding for this program?

h. Organizational Capacity: Who is primarily responsible for the project, and what is their
   role within your organization? What organizational support will they receive (i.e. who
   else has a role in this project, and what are their responsibilities)? Please also include
   a description of executive management within your organization, including financial
   management.

i. Partnerships: Provide detailed information on any partners that you have or will contact
   regarding collaboration on the project, including their responsibilities or contributions to
   the project. You are encouraged to provide up to three letters from project partners
   describing their roles in and commitment to the project.




                                               2
    18. Proposed Budget

                               Willie Nelson Concert Proceeds
                                    GRANT APPLICATION
                  Administered by the Red Lodge Area Community Foundation
           Budget               Concert           Other       Total Budget          Funding currently
          Categories           Proceeds          Funding                           available for project
    a. Personnel           $                 $                $                $
    b. Fringe Benefits
    c. Travel
    d. Equipment
    e. Supplies
    f. Contractual
    g. Construction
    h. Other
    Total Costs

    19. Budget Narrative: Provide a brief but substantive narrative for each budget category.
        Each section should clearly explain and justify the proposed costs for that category.
        a. Personnel.
        b. Fringe Benefits.
        c. Travel.
        d. Equipment.
        e. Supplies.
        f. Contractual.
        g. Construction.
        h. Other.

    20. Financial Reports: Please attach financial information for your organization that
        includes:
            (a) last fiscal year's (2009) actual expenses and revenues (for the entire
                 organization;
            (b) your current fiscal year's (2010) total projected budget for expenses and
                 revenues; and
            (c) total assets and liabilities of your organization, including any endowment
                 funds.

    21. Authorized Signature


                                Signature of board’s presiding officer is required.
Signature:                                                 Date:
Printed Name:                                              Title:




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