F3F Palmetto North
GRANT APPLICATION FORM
1. ORGANIZATION
Date of Application:
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Name of Organization:
Project Title
Address
City/State/Zip
Telephone
Website
Contact at Organization & Title
Contact for this Application (include phone and email)
2. ELIGIBILITY FOR FOUNDATION INVOLVEMENT
In order for an organization or service project to qualify for an F3F grant or support, it must meet
all of the following guidelines.
a) How does the requested grant promote the F3F mission – to develop and strengthen Male Leadership in this community?
b) List at least two F3 members actively involved with the organization or project.
c) List the two F3 members that will accept responsibility as co-QIC’s for the proposed grant.
d) Briefly describe the local presence of this organization or project.
3. PROPOSAL INFORMATION
Please give a 2-3 sentence summary of the grant request:
Funds are being requested for (check one)
Column 1
General operating support
Project/program support
Start-up Costs
Capital
Other (list)
Project dates (if applicable)
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Fiscal year end
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4. BUDGET
Specific Amount Requested from F3 Foundation: $ (Include: Itemized budget for this project and total program, your current sources of income and expenses, a balance sheet for the past year, and contributions from other institutions or organizations, if any.)
Do you have any other sources of funding for this project?
Also, what are your plans for financial support after the grant expires?
5. TARGET POPULATION
Please summarize your target population in measurable terms (i.e., who the primary audience is,how many will be served, how old are the participants, and where the program is offered, and the geographic range of your organization)
6. HISTORY
Please provide us with a brief history of your organization, including the date your organization was established. What are the organization mission and goals? Provide a brief description of the organization’s current programs or activities.
5. SUMMARY
Please provide a concise description of the need or problem to be addressed by this grant. Include the overall goals and purposes of F3F’s involvement or specific department concerned, the specific purpose for the use of the funds, and the how the objectives will be accomplished. Also,please describe the timetable for the project
6. EVALUATION
How will you determine the impact on this project? Please be specific.
Who will have the responsibility for evaluating whether the above criteria have been met?
7. OTHER
Have you previously applied for or received funding from F3 Foundation? If so, please signify name of project and date applied, and if funding was received.
Do you have other proposals pending for this project? If yes, please list agencies and amounts.
8. ATTACHMENTS
a. A brief history of the agency or organization. b. Most recent audited financial statement. If agency has no audited financial statement, submit the most recent IRS Form 990.
c. Copy of the IRS approval letter of tax-exempt status - 501(c)3.
d. List of your Board of Directors, their affiliation, addresses, and telephone numbers. e. Detailed financial forms previously requested (item #2) in this application. f. Latest annual report, if applicable.g. Minutes of the last two Board Meetings
9. TERMS
Grants will be made directly to fund both new and existing projects and programs that
develop and strengthen male leadership in the Charlotte community
• At least two F3 members will continue to be actively involved in your organization or a
program affiliated with your organization
• The grant will be used only for the specific initiative that you described in this grant
proposal
• You agree to provide a final written report and an accounting of how the funds were
utilized by your organization
• You acknowledge that F3 Foundation could withhold and/or recover grant funds that
were misused by your organization
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