(To receive a Word version of this form, send an email request to:  "ORBRCF Treasurer" at dubshults@comcast.net.)

 

Application Form

for

Community Action Grant

 

Complete this form and mail it and the required attachments plus four copies to:  Grant Application, ORBRC Foundation, P. O. Box 4164, Oak Ridge, TN 37831-4164.

 

Applicant Information

 

Name of Applicant/Organization:  ____________________________________________

Mailing Address:  __________________________________________________________

Status:  501(c)3 _____   Government Entity:  _____   Local:  _____   Other:  _____

Director/President:  ________________________ Title:  __________________________

Contact Information:  Phone:  ________________ Email:  _________________________

Project Leader:   ___________________________ Title:  __________________________

Contact Information:   Phone:  ________________ Email:  _________________________

Funding Request:   $__________  Projected Start Date:  ___________________________

 

Please enter here a brief description of the Applicant Organization’s history, purpose, constituents, and funding sources. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature:  ___________________________________   Date:   ______________________

Grant Information

 

Please enter here details of the proposed project, e.g., goals of the project, plan for attaining those goals, how will the funds by used, who will benefit, and how will the outcomes be evaluated.  Please identify other organizations that may partner in this project.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Projected Expenses

 

                        Administration:                      $____________                     

                        Fees, Services:                        $____________

                        Travel:                                     $____________

                        Equipment, Supplies:             $____________

                        Other:                                     $____________

                        Total:                                      $____________

 

 

Comments:

 

 

 

 

 

 

 

 

 

Notes

 

  1. Successful grantees must submit a final report of accomplishments and expenses at the end of the project or no later than June 14 after the grant approval date.

 

  1. A grant application package will contain:

-One completed application form bearing an original signature along with a copy of the organization’s tax determination (501(c)3) letter, if applicable

-A list of the organization’s Board of Directors

-Four additional copies of the original application form

-A letter from the Applicant Organization that indicates its agreement to accept, monitor, and account for grant funds

 

  1. A grant application may contain supporting brochures or supplementary material related to the Applicant Organization or the proposed project.

 

  1. Complete Application packages should be mailed to:

 

                                                Grant Application

                                                ORBRC Foundation

                                                P. O. Box 4164

                                                Oak Ridge, TN  37831-4164

 

  1. The Community Action Grant program operates on the following schedule:

            -Applications are accepted:               March 1 through April 30

            -Grants are awarded:                         June 1 through June 15

            -Final reports submitted:                  June 14 of the following year