Organizational Chart Not for Profit - DOC

Document Sample
Organizational Chart Not for Profit - DOC Powered By Docstoc
					This application MUST be used for all grant requests. Please include the


Applicants MUST complete all sections of this application.

Please limit the Grant Summary (items 1, 2, & 3) to space allocated and to
the front side ONLY.

Do not attach additional information beyond what has been requested. It will
not be considered.

Thank you for your cooperation.

Page 1                                                         11/22/2010
Thank you for contacting Speedway Children’s Charities, Sonoma Chapter, regarding funding for your
special program. As you may know, we are a foundation dedicated to HELPING CHILDREN. We
produce and coordinate various events throughout the year to raise funds to distribute to worthy
children’s organizations; therefore, it is our pleasure to enclose a 2008 SCC Grant Application. For
your convenience, you can download this document on our national website: and click on the Infineon Raceway link.

SCC is a 501 (C) (3) non-profit charity with the purpose of raising funds for qualified children’s
organizations. Only non-profit charities, which are tax exempt for federal (and state, if applicable)
income tax purposes are eligible. Grants will not be made to organizations that discriminate on the
basis of race, color, sex, creed or national origin.

All requests must be submitted using this SCC Grant Application. Due to the large volume of
requests, SCC is unable to grant every proposal. Applicants should understand that a declined
proposal does not reflect on their organization. It is simply a matter of funding limitations. Charities
that are awarded grants SHOULD NOT consider these funds as part of their annual budget.

All applications must be completed and returned in person or received by mail to SCC at Infineon
Raceway by 5 P.M. on September 30, 2008. Applications will NOT be accepted via email or fax.
Grant applications must be completed in their entirety to be accepted. The following must be included
with the submitted application:

             2 SCC grant applications
             2 copies of your IRS 501 (C) (3) determination letter
             2 copies of your 2007 financials
             2 copies of your Board of Directors
             2 copies of your mission statement and organizational chart
             2 copies of each insert/brochure (if applicable)

Thank you again for your interest in Speedway Children’s Charities. We wish you only the best in all
your endeavors on behalf of the children.


Denise Silver
Community Events Coordinator 707-933-3950, email:
Speedway Children’s Charities, Infineon Raceway

Page 2                                                                               11/22/2010
                               GRANT APPLICATION COVER SHEET

Date of Application: ___________Tax ID:____________________ Year Founded: ___________
Legal name of organization applying:__________________________________________________
                                   (Should be same as on IRS determination letter)
Executive Director: ____________________________ Phone number________________________
Contact person/title/phone number (if different from executive director)
Address (principal/administrative office): ______________________________________________
City/State/Zip: _______________________________________________________________________
Fax Number: ______________________E-mail Address: __________________________________
List any previous support from SCC in the last 3 years: ________________________________
Program Name:_______________________________________________________________________
Purpose of Grant (one sentence): _____________________________________________________
Planned Project Start Date: ___________Planned Completion Date:______________________
Amount Requested: $______________________Total Program Cost: $_____________________
Current Operating Budget: _________________________
________% of Operating Budget for Admin/Fundraising
________% of Operating Budget for this project
________% of Operating Budget serving children & youth
# Children Who Will Benefit from This Program ______________________________________

             _____________________________________        __________________
             Signature, Chairperson, Board of Directors                   Date
               ___________________________________                        __________________
             Signature, Executive Director                        Date

Page 3                                                                                   11/22/2010
              GRANT REQUEST SUMMARY                              USE FRONT SIDE ONLY
              Organization Name:                                 Contact:
              Program Name:                                      Phone number:
              Planned start date:                                Past Grant Recipient?
              Planned completion date:                           Year:     Amount of Grant

      1.       Project Narrative (Please do not use back-side of this sheet)
              Provide a brief description of the program or project for which funding is requested. Please
              include costs, goals, staffing, methods and population of children served. Also include who
              will be responsible for evaluating this program.

     2.       Program Budget, Duration & Other Funding (Please do not use back-side of this sheet)
              Describe the duration of the program and if it is ongoing, include the long-term strategies
              for funding at the end of the grant period, overall budget and other sources of financial
              support. (Grants, city, state or federal support, fundraisers, etc.)

3.         Fiscal Information of Application Organization
           Attach income and expense reports for the years 2007 and 2008 and your budget for 2009.
           (Please indicate with a check each year of statements enclosed with this grant application.)
                           ___2007             ___2008      ___2009 Budget (if available)

           Grant Amount Requested: $________
           Percent of Program’s Total Budget: %______
           Total Budget for this Program: $_________
4. Project/Project Budget—Current Request

Page 4                                                                                   11/22/2010
* If you already prepare project budgets that contain this information, you may submit them in their
original form or you may redo this form as long as all elements are included. You may attach a brief
narrative explaining the budget if necessary.

                          PROGRAM/PROJECT INCOME                         Fiscal Year: ________

                                                            Amount           Amount       Anticipated
                         Source                            Committed         Pending*    Decision Date

         Government grants                         $                     $
         Foundations                               $                     $
         Corporations                              $                     $
         United Way or federated campaigns         $                     $
         Individual contributions                  $                     $
         Fundraising events and products           $                     $
         Membership income                         $                     $
         In-kind support                           $                     $
         Investment income                         $                     $
         Speedway Children’s Charities             $                     $

         Government contracts                      $                     $
         Earned income                             $                     $
         Other (specify)                           $                     $
                                                   $                     $
         Total Income                              $                     $
*Note: Pending sources of support include those requests currently under consideration. Please indicate
anticipated decision date.PROGRAM/PROJECT EXPENSES

         Item                                                   Amount         %FT/PT
         Salaries and wages (break down by
         individual position and indicate full- or part-
         time.)                                                 $
         SUBTOTAL                                               $
         Insurance, benefits and other related taxes            $
5.       Consultants and professional fees                      $
         Travel                                                 $
         Equipment                                              $
         Supplies                                               $
         Printing and copying                                   $
         Telephone and fax                                      $
         Postage and delivery                                   $
         Rent and utilities                                     $
         In-kind expenses                                       $
         Depreciation                                           $
         Other (specify)                                        $
                         Total Expense                          $
         Difference (Income less Expense)                       $

Page 5                                                                                      11/22/2010
         We certify that the information contained in the application, including all attachments, is true
         and correct to the best of our knowledge.

__________________________                         __________________________
Signature, President of Board of                   Signature, Project Coordinator
Directors/Authorizing Official

__________________________                         __________________________

__________________________                         __________________________

__________________________                         __________________________

__________________________                         __________________________
Type name, position, address,                      Type name, position, address,
phone number and email of                          phone number and email of
person above                                       person above

               Please submit no later than September 30, 2008 to the address below:

                                      Speedway Children’s Charities
                                  Infineon Raceway Attn. Denise Silver
                                           Highways 37 & 121
                                           Sonoma, CA 95476

               (Applications received after the deadline will not be considered for funding.)

           For questions, contact Denise Silver, Community Events Coordinator 707-933-3950

Page 6                                                                                    11/22/2010

Description: Organizational Chart Not for Profit document sample