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Grant Application
ORANGE COUNTY COMMUNITY FOUNDATION, INC
112 West Water Street
Paoli, IN 47454
(812)723-4150
orangecountycommunityfoundation.org
No Grant Cycle currently in effect. However, you may submit a letter of inquiry any time.
Organization:________________________________________
Date:________________
Address: _________________________________ City:____________ Zip:___________
Phone:______________ Fax: _________________________ email: ______________
Director: ____________________________Contact Person: ______________________
PROJECT TITLE: ________________________________________________________
Amount Requested: $____________________ Total Project Cost: $________________
A copy of your 501c(3) documentation is required, and will be kept on file at the OCCF
office.(if not previously submitted)
PROJECT INFORMATION:
I. A. Project Summary:
A concise summary (two or three paragraphs) of the proposed project.
State the community need being addressed by the project and why organization is qualified
to address the need. Describe how the proposed project will further the organization’s
overall mission.
B. Funding: Summarize
Amount being requested from the Foundation.
How funds from the Foundation will be used.
Additional resources for funding, if available. Describe.
If project could not be funded fully, would you be interested in a challenge grant?
What percentage of your board supports your organization financially?
C. Implementation:
How will the project be implemented?
Whom will it serve?
How many people will be affected?
What are the expected outcomes and accomplishments?
What provisions exist for continuing the project beyond this grant?
D. Timetable:
Chart significant dates of implementation and project schedule.
E. Evaluation:
Summarize:
What has been your success with similar projects?
How do you plan to evaluate this project?
How will you measure its success?
What tools will be used to evaluate the project?
F. Are you affiliated with any sectarian or religious group?
G. Please list the names and amounts from other sources contributing 10% or
more of your total budget in the past 2 years.
H. Project Period: from_________________to__________________
PROJECT NAME:_____________________________________________________
ORGANIZATION:____________________________________________________
II. PROJECT FINANCIAL INFORMATION:
Insert this worksheet in the funding section of your proposal. Your project budget should
reflect all expenses and funding sources for the project. Please attach any documentation
you feel relevant to this proposed budget.
List Project Expenses: (description and amount)
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
______________________________________________________________
TOTAL $______________________
List Project Funding Sources: (source and amount)
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
______________
TOTAL $________________________
*This application must be signed by the Chair or another non-paid officer of the agency’s
governing body.
_______________________________________ ______________________
Signature Title
_______________________________________
Print Name
*Name of program director or person from whom further information may be obtained:
___________________________ ___________________ __________________
Name Title Telephone
FOR OFFICE USE ONLY
Date Received: __________________ Proposal #_________________
Telephone Contact: _____________________________________________
Acknowledgment sent: ____________ Category __________________
Action Taken: Approved ___________ Declined___________________
DISTRIBUTION INFORMATION:
Amount approved: $_________________ Fund: ___________________________
Distribution Schedule: Date: _______________ Amount: ______________
Date: _______________ Amount: ______________
Date: _______________ Amount: ______________
Date: _______________ Amount: ______________
Approval Letter date: ________________ Decline Letter date: ___________________
Evaluation due dates: ___________ ____________ __________ _____________
112 West Water Street
Paoli, IN 47454
(812)723-4150
orangecountycommunityfoundation.org
No Grant Cycle currently in effect. However, you may submit a letter of inquiry any time.
Organization:________________________________________
Date:________________
Address: _________________________________ City:____________ Zip:___________
Phone:______________ Fax: _________________________ email: ______________
Director: ____________________________Contact Person: ______________________
PROJECT TITLE: ________________________________________________________
Amount Requested: $____________________ Total Project Cost: $________________
A copy of your 501c(3) documentation is required, and will be kept on file at the OCCF
office.(if not previously submitted)
PROJECT INFORMATION:
I. A. Project Summary:
A concise summary (two or three paragraphs) of the proposed project.
State the community need being addressed by the project and why organization is qualified
to address the need. Describe how the proposed project will further the organization’s
overall mission.
B. Funding: Summarize
Amount being requested from the Foundation.
How funds from the Foundation will be used.
Additional resources for funding, if available. Describe.
If project could not be funded fully, would you be interested in a challenge grant?
What percentage of your board supports your organization financially?
C. Implementation:
How will the project be implemented?
Whom will it serve?
How many people will be affected?
What are the expected outcomes and accomplishments?
What provisions exist for continuing the project beyond this grant?
D. Timetable:
Chart significant dates of implementation and project schedule.
E. Evaluation:
Summarize:
What has been your success with similar projects?
How do you plan to evaluate this project?
How will you measure its success?
What tools will be used to evaluate the project?
F. Are you affiliated with any sectarian or religious group?
G. Please list the names and amounts from other sources contributing 10% or
more of your total budget in the past 2 years.
H. Project Period: from_________________to__________________
PROJECT NAME:_____________________________________________________
ORGANIZATION:____________________________________________________
II. PROJECT FINANCIAL INFORMATION:
Insert this worksheet in the funding section of your proposal. Your project budget should
reflect all expenses and funding sources for the project. Please attach any documentation
you feel relevant to this proposed budget.
List Project Expenses: (description and amount)
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
______________________________________________________________
TOTAL $______________________
List Project Funding Sources: (source and amount)
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
______________
TOTAL $________________________
*This application must be signed by the Chair or another non-paid officer of the agency’s
governing body.
_______________________________________ ______________________
Signature Title
_______________________________________
Print Name
*Name of program director or person from whom further information may be obtained:
___________________________ ___________________ __________________
Name Title Telephone
FOR OFFICE USE ONLY
Date Received: __________________ Proposal #_________________
Telephone Contact: _____________________________________________
Acknowledgment sent: ____________ Category __________________
Action Taken: Approved ___________ Declined___________________
DISTRIBUTION INFORMATION:
Amount approved: $_________________ Fund: ___________________________
Distribution Schedule: Date: _______________ Amount: ______________
Date: _______________ Amount: ______________
Date: _______________ Amount: ______________
Date: _______________ Amount: ______________
Approval Letter date: ________________ Decline Letter date: ___________________
Evaluation due dates: ___________ ____________ __________ _____________