5 Promises

Five Promises for Children Foundation, Inc.

- Grant Application Form

P.O. Box 1468
Charleston, WV 25325

Phone:304-382-7498
Web:info@5promiseswv.org

The Maximum grant amount is $5,000.00.

Grant Application

Completing this application form allows the foundation to give consideration to your request for funding. With respect to any grant and to comply with legal requirements the foundation may seek information about your organization and the people involved with your grant.

1. Organization Information

Please provide details about your organization.
Name of Organization *
Mailing Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code
Website *
e.g. http://www.acmecorp.com/
Email *
Phone Number * - ### - ### ####
Fax * - ### - ### ####
2. Supporting Organizations

Please provide details about your supporting organizations.
# of Supporting Organizations *
3. Project Summary

Please provide details about your project.
Name of Project *
Project Summary *
One Sentence Summary of Project
Requested Amount * $ . Dollars Cents
Contact Name & Title *
Contact Name & Title for the Project
Email *
Phone Number * - ### - ### ####
Fax * - ### - ### ####
4. Grant Proposal Outline

Please provide detailed information about your grant proposal.
Primary Organization History *
Provide a brief narrative of the organization seeking funding. Include: mission and purpose; how long it has been in existence; services provided; and geographic area served.
Project Description *
Describe the project by including the following information: issues being addressed, promises involved in the project, strategies and activities, goals and objectives of the project, targeted population to be served, and geographic area to be served.
Outcomes *
List the actual impacts/benefits/changes projected as a result of this project and how you will measure success of these outcomes.
Implementation Plan *
List the steps of project implementation, related activities, and beginning and ending dates for the project.
Project Budget *
Project Grant Request * $ . Dollars Cents
Anticipated Expenses * $ . Dollars Cents
Anticipated Support (in-kind and other) * $ . Dollars Cents
Anticipated Revenue * $ . Dollars Cents
Project Scope *
Define the scope of the project (one time event or ongoing initiative).
By submitting this application, the undersigned hereby certifies that the organization applying for a grant from Five Promises For Children Foundation, Inc. is recognized by the Internal Revenue Service as exempt from taxation under section 501(c)(3) of the Internal Revenue Code of 1986. The undersigned, after due inquiry, has no knowledge of any inquiry or investigation by the Internal Revenue Service regarding the tax exempt status of the applicant.

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5 Promises

Grant Application

1. Organization Information

2. Supporting Organizations

3. Project Summary

4. Grant Proposal Outline