Robert G. Boehmler Community Foundation Grant Application
Instructions: Please fill out the grant application summary below. Optional: you may wish to follow the model on the second page to describe your project in 1-2 additional pages. We expect a follow-up communication explaining how the funds were used and the result.
Today's Date
Organization Name
I am applying as a:
501(c)(3) Organization
Church
School
Address
Contact Person
Phone Number
Email
Fax Number
Date On Which Fiscal Year Begins
Date Incorporated
Total Annual Agency Budget
Program Budget
Amount Request
Date When Funding Is Needed
Purpose Of Request
Project Title
Program/Project Start Date
Is this a new program for your organization?
Yes
No
Have you previously received funding from this Foundation?
Yes
No
Principal Sources of Your Support
Please provide the percentage of support from each source below.
% United Way
% Foundations/Corporations
% Government Grants
% Earned Income
% Individual Contribution
Grant Application to Robert G. Boehmler Community Foundation
Please fill out the formal grant application below and submit proof of your organization's 501(c)(3) designation.
Organization's Mission:
Project:
Participants:
Geographical Areas to be Served:
The Project Activities:
Anticipated Outcomes:
Amount Requested:
Methods for Monitoring Progress:
Please Submit Proof of 501(c)(3) Designation.
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