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Grants Application Janvrin

Janvrin Fund Grant Application

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Step 1 of 7

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COMPLETE THIS APPLICATION FOR FUNDING REQUESTS FOR THE Mary Janvrin and Natalie Janvrin Wiggins Fund for Birds, Other Animals, and Nature.

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. Complete all questions; review instructions document for full details before completing.

The required Project Budget listed in Section V must be submitted on the CFMC Summary Budget Template available on our website.

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 government agency or religious organization, please contact Thayer Talbott, 860.347.0025, for further information before completing the application.

Project / Program Name*

Dollar Amount Requested $*

Total Project Cost $*

Summary Statement

Short summary of your request (used in materials and database) - maximum 500 characters with spaces.

II. Funding Request Information

Proposal / Purpose

Detailed proposal, including needs, issues, services, goals and objectives, identified challenges and how to meet them. (Maximum of 7,500 characters - includes spaces, tabs, bullets, and other characters)

Sustainability and Assessment

Strategies moving forward; assessing success; measures to be used to track work; how funding supports the overall sustainability (Maximum of 5000 characters - includes spaces, tabs, bullets, and other characters)

III. Information

The following questions apply to the purpose of the application - if program/project specific, responses should tie to details included in the Proposal question in section II.

Grant Type*

Target Demographics

Select all that apply

Birds

Animals

Other Wildlife

Adults

Young Adults (ages 18-25)

Youth (ages 13-17)

Children (ages 6-12)

Birth to 5 years old

Families

Retirees

Students

Veterans

BIPOC

LGBTQIA+

Other

If you selected Other, provide key words:

Geographic Area Served (Select One)

All of Middlesex County

Upper County (Durham/Haddam/East Haddam and North)

Lower County (Killingworth/Chester and South)

Total Number of People in Middlesex County Personally Impacted by this proposal

Geographic Details

Please designate a town or towns you are serving through this proposal.
If you selected All Middlesex County, you do not need to complete this question.

Chester

Clinton

Cromwell

Deep River

Durham

East Haddam

East Hampton

Essex

Haddam

Killingworth

Middlefield

Middletown

Old Saybrook

Portland

Westbrook

Collaborators / Partners

List each organization that may collaborate on this project. Include the name of the organization and the name of Executive Director or CEO, and if the organization has committed to partnering or will be approached to partner. (To add additional lines, click the "+" side on the far right of the current line)

Organization

CEO / Executive Director

Committed / Pending

IV. Organization 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/virtually

Date most recent IRS Form 990 filed:

MM slash DD slash YYYY

Year of Return

Organization's Fiscal Year

Organization's Total Operating Budget

Brief Background Statement

Brief background of the organization (Maximum 750 characts - including spaces, tabs, bullets, and other characters)

V. Additional Information

Please Note: Documents requested must be uploaded in PDF format only. Other document formats will not be accepted by the form. Attempts to upload other file formats could result in a loss of all application data entered.Additional financial document, including the organization's most recent audit, annual report, and/or IRS Form 990 may also be required. Only provide this information if requested.

A. Current Organization Operations Budget

Accepted file types: pdf, Max. file size: 2 MB.

B. Board of Directors and Officers

Please include professional affiliation and town of residence.

Accepted file types: pdf, Max. file size: 2 MB.

C. IRS Tax Determination Letter

Accepted file types: pdf, Max. file size: 2 MB.

D. CFMC Budget Summary Form for Program/Project

Please use the CFMC Budget Summary Template form provided on the Janvrin Fund Application Information page with the instructions document.

Accepted file types: pdf, Max. file size: 2 MB.

E. Organizations serving regions 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 a format similar to the CFMC Budget Summary Template (available on the application information page). Please include the portion of expenses related to your overall work in Middlesex County as well as revenue supporting that work.

Accepted file types: pdf, Max. file size: 2 MB.

F. America Rescue Plan Act (ARPA)

Has your organization applied for and received - or plans to apply for - ARPA funding?

ARPA Funding

If your organization plans to apply for - or has applied for and the decision is pending - or the award has been received - ARPA Funding, please complete the following. (To add additional lines, click the "+" sign to the far right of the current line.)

Designate Will Apply, Pending, or Have Been Approved/Received

Amount Requested / Approved

VI. Organization Contact Information

Are you a new nonprofit applicant to the Community Foundation?

Executive Officer's Name*

Title*

Phone*

Email*

Contact Person

For this application, if different from above.

Contact Person Title

Contact Person Phone

Contact Person 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

Note: Social Media Platforms such as Facebook, Twitter, Instagram
Organization's page name is @__________ or other identifier

Social Media Platform

Organization's page name

VII. Requirements and Certifications

Marketing and Public Relations and Evaluation Requirements

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. 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/.
Furthermore, all CFMC grantees are required to submit a final evaluation regarding the use of CFMC funding and the outcomes, achievements, and results such funding supported. The evaluation requirements include qualitative and quantitative information, photos, stories, and examples of public acknowledgement of the award.
By signing the application below, the CEO/Executive Director/President understands the Community Foundation’s marketing and public relations requirements and evaluation requirements if awarded a grant.

Tax Exempt Standing and Use of Grant Funding Certification

By signing this application, the CEO/Executive Director/President is certifying that your organization is a qualified 501(c)3 organization or other charitable organization recognized and currently in good standing with the IRS, or 170(c)1 governmental agency. Should a grant be approved by the Community Foundation of Middlesex County, these funds may only be used for the purposes outlined in your original application; you must notify the Community Foundation if you are unable to do so. If grant funding is provided, you may only use these funds for charitable purposes 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*

MM slash DD slash YYYY

Partner / Collaborator Attestation

If your organization is partnering/collaborating with other nonprofit(s), the following electronic entry of name, title, and email address of each partner constitutes that the organization is aware of and agrees to all of the Community Foundation's requirements and expectations, including, but not limited to, the PR/Marketing and Evaluation requirements, the Use of Grant Funding Certification, and the CFMC Nondiscrimination Policy posted on the Guidelines page on our website. The following Executive Director or Board of Director Chairperson listed below affirms the following: I certify that my printed name as stated and assigned below constitutes my signature and may be accepted as such. (To add additional lines, click the "+" sign to the far right of the current line.)

Partner/Collaborator Signature

Name

Title

Organization

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