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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: 3
"Willie Nelson Concert Proceeds "