Central Wyoming Grantmakers Hub - Application Information

Common Application

Organization Name:
Physical Address:
City:
State:
Zip:
Mailing Address (if different):
City:
State:
Zip:
Fax:
Email:
Website:
Executive Director:

Phone:
Board Chair:

Phone:
Geographic Area Served:
Organization Description:
Federal Tax ID #:
Is your organization recognized by the IRS as a 501(c)(3) organization?

YESNO

OR is your organization an applicant for 501(c)(3) status?

YESNO

Date Filed:
Is your organization a public/government agency?

YESNO

Project Information

Project Name
Project Contact Name:
Phone:
Address
Charitable Field Other:
Amount Of This Funding Request:
Brief Description Of Request:

Organizational Information

History Of The Organization:
Expertise Of The Organization:
Organizational Mission, Purpose, Goals:
Whom Have You Traditionally Served:
Summary Of Principal Programs And Accomplishments
Relationship with other organizations offering similar services (working relationship, collaborative efforts, factors that make your organization unique)

Project Description

The problem or opportunity to be addressed
Target population and geographic area to be served
Specific purpose and amount of grant request
What You Plan To Do
Who will carry out those activities?
Timeline for project/program implementation
Unique aspects of the project/program and relationships/collaborations with other organizations

Evaluation

Specific objectives/outcomes expected (in relation to the stated problem or opportunity)
How will you evaluate the progress and success of your project?
Who will assess the results?
Plans for on-going funding once this grant period ends

Budget And Financial Information

Budgets

Please list all entities asked to provide financial support for the proposed project/program (indicate whether pending or confirmed, and amounts)
Description of state and federal funding this project/program receives (indicate percentage of total program budget)

Note: For applicants requesting more than $10,000, please consider uploading the following:

List of board members with occupations/community affiliations
Names, position, qualifications, and length of service of key staff members
Letters of support from any cooperating organizations
Copy of IRS tax determination letter dated within last 10 years
Agency budget for current fiscal year
Agency budget for previous fiscal year
Project/program budget for the year for which funding is requested (including expenses and revenue)
Audit or financial review by a Certified Public Accountant (including Income Statement, Balance Sheet, and Statement of Cash Flows) for organization's most recently completed fiscal year.
Copy of most recent IRS Form 990
Pictures of your program in action

Files (maximum 10):

After submitting this application, we will forward your application to our members whose funding areas match your request. We will contact you shortly to confirm the grantmakers who that will receive this application.