Grant Application Competitive

I. Application Information

Legal Name of Organization*

Division or Department Name (if applicable)

Are you a 501(c)3 Organization

Yes

No

Other Tax Exempt Entity?

If applicable.

EIN #

If your organization is not a 501(c) 3 tax exempt entity or division/department of a 170(c)1 government agency or religious organization, please contact Thayer Talbott, 860.347.0025, for further information before completing the application.

Dollar Amount Requested $*

Total Cost associated with request $*

Summary Statement

No more than two sentences describing what the grant will fund. (Response limited to 500 characters with spaces.)

II. Funding Request Information

1. Proposal / Purpose

State the needs or issues to be addressed or services furnished with funding, including goals and objectives, and any identified challenges and how you propose to meet them. (Maximum of 7,500 characters with spaces)

2. Sustainability and Assessing Impact

What are your strategies moving forward? How will you know if the project/program is successful? What specific measures will be used to track whether your work is succeeding?
If this is a program or project, will it be incorporated into your organization's annual outreach and services? If this is a technical, equipment, or capacity building application, please explain how this assists your organization in its overall sustainability. (Maximum of 5,000 characters with spaces)

IV. Organization Information

Board of Directors / Trustees Information

Total Number of Directors/Trustees:

Percent (%) of Directors/Trustees who contribute annually to Operations

Total Number of Board meetings held last year:

Average number attending in person:

(including "virtually" via Zoom, WebEx, Google Meetings, or other video meeting platform)

Date most recent IRS Form 990 was filed:

Year of Return:

Organization's Fiscal Year

Please select one:

Jan 1 - Dec 31

July 1 - June 30

Other

Organization's Total Operating Budget

Please provide the current Fiscal Year Operating Budget:

Please enter a number from 1 to 9999999999.

Division Operating Budget Information

If you are a division or department of a large "parent" organization, and have a separate operating budget from the "parent" organization, what percentage of your division/department is funded by the "parent" organization? (if applicable)

Please enter a number from 1 to 100.

National Organization Chapter Information

If your organization is a state, regional, or local chapter or affiliate of a national organization, what percentage administration fee do you provide to the national organization? (if applicable)

Please enter a number from 1 to 100.

Did you RECEIVE a competitive process grant in the:

(please check all that apply.)

2023-2024 process (fall 2023 or spring 2024)

2024-2025 process (fall 2024 or spring 2025)

2025-2026 process (fall 2025 or spring 2026)

Brief Background Statement of the Organization:

Provide a brief background statement about the organization. You may include a short summary of the organization's history, programs and services, and mission. (Maximum of 750 characters)

V. Additional Information To Be Included with the Application

Please Note: Additional information requested below MUST be uploaded in PDF files. Other document formats will not be accepted by the application form. Attempts to upload other file formats could result in a loss of all application data entered.

A. Current Organization Operations Budget (Required)

one-page summary of the organization's current operating budget (expense and revenue).

NOTE: the document MUST be uploaded in PDF FORMAT.

Accepted file types: pdf, Max. file size: 256 MB.

B. Board of Directors and Officers List (Required)

list of current Board of Directors and officers with professional affiliations.

NOTE: the document MUST be uploaded in PDF FORMAT.

Accepted file types: pdf, Max. file size: 256 MB.

C. IRS Tax Exempt Determination Letter

Attach a copy of your IRS tax exempt determination letter (required for 501c3 organizations) or other tax exempt status documentation.

NOTE: the document MUST be uploaded in PDF FORMAT.

Accepted file types: pdf, Max. file size: 256 MB.

D. For Program/Project Requests only - CFMC Budget Summary Form:

The Community Foundation’s Budget Summary Form is required for program/project-specific requests.

The Summary Form is available on the CFMC website in Word. Please download the form, complete, and Save as PDF.

NOTE: The budget document MUST be uploaded in PDF FORMAT.

Please provide a one page itemized budget of income and expenses related to the application request, including the amount raised or expected from other sources. If the application request is ongoing, please provide an explanation of how it will be funded in the future.

Accepted file types: pdf, Max. file size: 256 MB.

E. Organizations serving a region greater than Middlesex County - county-based budget summary:

501(c)3 organizations with a service footprint greater than Middlesex County, please provide a summary operations expense/revenue budget for the Middlesex County portion of your service footprint.

The budget document MUST be uploaded in PDF FORMAT.

You may use a format similar to your organization's operations budget presentation or you may use the CFMC Summary Budget Form. Please include the portion of expenses related to your work in Middlesex County as well as revenue supporting that work.

Accepted file types: pdf, Max. file size: 256 MB.

Additional financial documentation, including the organization’s most recent audit, annual report, and IRS Form 990 may also be required. Only provide this information if requested.

For programs or projects which are collaborations among two or more organizations or where an organization provides in-school or after-school programming for schools, the Community Foundation requires a list of organizations or schools partnering with your organization as well as Letters of Support.

For the purposes of this application, collaborations are defined as partnerships where two or more agencies are committed through staffing, funding, and resource allocation to the goals and objectives of the program described. Because the nature of the collaboration requires two or more entities to works together, for the purposes of funding, only one organization may complete the application, and in doing so, accepts responsibility for all evaluative and fiduciary reporting.

For all collaborations, the Community Foundation requires letters of support from the non-applicant organization(s) and/or from the school(s) and school district(s) at which the applicant organization is the program.

Is this application a collaboration of two or more nonprofit organizations (NOT schools)?

Yes (Letter(s) of Support REQUIRED)

No

Is this application in collaboration with a School(s) or School District(s)?

Yes (Letter(s) of Support REQUIRED)

No

If Yes, is this a New or On-Going Collaboration?

New

On-going

If this is an On-Going Collaboration, how long has the collaboration existed?

List of Collaborators

If this application is a collaboration among two or more organizations or in conjunction with school(s) or a school district, list each organization. Include the name of the organization and the name of Executive Director or CEO.

Letters of Support (if a collaboration with schools or other nonprofits))

if the program or project is in collaboration with one or more organizations OR if the program or project is in conjunction with a school or school district, Letters of Support are required. Please see Application Instructions and Guidelines for details on what should be submitted.

NOTE: all documents MUST be uploaded in PDF FORMAT.

Drop files here or

Accepted file types: pdf, Max. file size: 256 MB.

VI. Organization Contact Information

Are you a new nonprofit applicant to the Community Foundation?

Yes

No

Executive Officer's Name*

Title*

Phone*

Ext.

Executive Officer Email*

Contact Person

For this application, if different from above.

Title

Phone

Ext.

Application Contact Email

Mailing Address

Street Address Address Line 2 City State ZIP Code

Street Address

If different than mailing address.

Street Address Address Line 2 City State ZIP Code

Website

Social Media Channels

Please provide links or identifying names (IDs) for your various social media channels - when inputting the information, please designate what social media channel each name is for (i.e. Facebook, Instagram, YouTube, Twitter, etc)

VII. Non-Funding Needs

Other than financial support, what are the top three areas or items that are of most concern or interest for your organization? (maximum 500 characters with spaces)

VIII. Marketing and Public Relations

Organizations receiving grants from the Community Foundation of Middlesex County must promote their funding awards according to the marketing and public relations guidelines established by the Community Foundation. By signing the application below, the CEO/Executive Director understands the Community Foundation’s marketing and public relations requirements if awarded a grant. The Community Foundation will host a seminar on marketing guidelines and tips for grantees annually. The Community Foundation’s Grantee Communications Kit may be downloaded on our website in the Nonprofit Resources section, middlesexcountycf.org/nonprofits/resources/forms-pr-guidelines/.

IX. Tax Exempt Standing and Use of Grant Funding Certification

By signing this application, the CEO/Executive Director/Board President is certifying that your organization is a qualified 501c3 organization or other charitable organization recognized and currently in good standing with the IRS, or 170(c)(1) governmental agencies. Should a grant be approved by the Community Foundation of Middlesex County, these funds may only be used for the purpose outlined in your original application; you must notify us if you are unable to do so. If grant funding is provided, you may only use these funds for charitable purpose as described in Section 170(c)2 of the IRS code, and funds may not be used for any political or lobbying activity. In addition, no tangible benefits, goods or services may be received by our donors or by staff members of the Community Foundation of Middlesex County in exchange for grant funding.

Signature Certification

I certify that my printed name as stated and assigned below constitutes my signature and may be accepted as such.

Printed Name*

Title*

Date*

Thanksgiving Drive Oct 1 - Nov 9

Requests for the competitive application cycle

I. Application Information

II. Funding Request Information

III. Grant Program / Project Information

IV. Organization Information

V. Additional Information To Be Included with the Application

VI. Organization Contact Information

VIII. Marketing and Public Relations

IX. Tax Exempt Standing and Use of Grant Funding Certification

Signature Certification

Thanksgiving Drive Oct 1 - Nov 9