Summary Checklist

Name of organization making request ___________________________________________

Project director or contact person _____________________________________________

Address ________________________________________________________________

Project title ______________________________________________________________

Total amount requested _____________________________________________________

Geographic region served by project or request ___________________________________

Is your tax-exempt status listed under another organization? __________________________

If so, which organization? Please describe relationship ______________________________

_______________________________________________________________________

Does this application include:

A copy of the IRS 501(c)(3) designation?	Yes	No
A mission statement?	Yes	No
Background or history of organization?	Yes	No
Demonstration of need?	Yes	No
Purpose of program or project?	Yes	No
Timeline for implementation?	Yes	No
Current financial statement?	Yes	No
Roster of board of directors?	Yes	No

 

 

 

 

 

 

Optional materials included (please list)? ____________________________________

_______________________________________________________________________

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