Grants Application - Special Purpose - Community Foundation Of Middlesex County

COMPLETE THIS APPLICATION FOR FUNDING REQUESTS FOR THE Community Foundation of Middlesex County.
Instructions: Complete the application on the website. You may "Save and Continue Later" - the site will email you a link which is active for 30 days. Review instructions document for full details before completing. Complete all questions.
Section IV requires certain documents to be uploaded to the form - see the Application Instructions Document for a list of the required items. All items must be uploaded as PDF Files.The required Project Budget form is available on the website in Word. This document must be submitted as PDF file as well.
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 Budget associated with request $*
Summary Statement
No more than two sentences describing what the grant will fund. (Response limited to 500 characters with spaces.)

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II. Funding Request Information
1. Proposal / Purpose
State the needs or issues to be addressed 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. Assessment and Sustainability
How will you evaluate your progress and impact? What are your strategies moving forward? (Maximum of 5,000 characters with spaces)

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IV. 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.
Program/Project/Purpose Application Budget:
Please upload an itemized budget document showing both anticipated/received revenue as well as anticipated expenses for the program or need addressed in the narrative section of this application. If the application request is ongoing, please provide an explanation of how it will be funded in the future. Further information will be requested by staff as needed.
NOTE: The budget document MUST be uploaded in PDF FORMAT.
Drop files here or
Accepted file types: pdf.
Organization Budget
Please upload an organization budget document showing both anticipated/received revenue as well as anticipated expenses. Further information will be requested by staff as needed.
NOTE: The budget document MUST be uploaded in PDF FORMAT.
Accepted file types: pdf.
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.
Board of Directors
Please upload a list of the current Board of Directors with their professional affiliations. The document must be uploaded in PDF format.
Accepted file types: pdf.
IRS Tax Exempt Status Determination Letter
Please upload the organization's 501c3 Tax Exempt Determination Letter or other not-for-profit status under charter document. The document must be uploaded in PDF format.
Accepted file types: pdf.
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)

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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 letter(s) of support from the collaborating organization(s).
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.
Is this application a collaboration of two or more nonprofit organizations (NOT schools)?
- Yes
- No
Is this application in collaboration with a School(s) or School Districts?
- Yes
- 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.
Letter(s) of Support from Collaborative Partners
Please upload letter(s) of support from organizations collaborating on this program or project.
NOTE: The document(s) MUST be uploaded in PDF FORMAT.
Drop files here or
Accepted file types: pdf.

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VI. Organization Contact Information
Executive Officer's Name*
Title*
Phone*
Executive Officer Email*
Contact Person
For this application, if different from above.
Title
Phone
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)

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VII. Non-Funding Needs
Other than financial support, how else might we support you? (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*
Date Format: MM slash DD slash YYYY

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Grants Application – Special Purpose

Grant Application Special Purpose

Step 1 of 7

COMPLETE THIS APPLICATION FOR FUNDING REQUESTS FOR THE Community Foundation of Middlesex County.

I. Application Information

II. Funding Request Information

III. Grant Program / Project Information

IV. 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

Grants Application – Special Purpose

Grant Application Special Purpose

Step 1 of 7

COMPLETE THIS APPLICATION FOR FUNDING REQUESTS FOR THE Community Foundation of Middlesex County.

I. Application Information

II. Funding Request Information

III. Grant Program / Project Information

IV. 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

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