Jefferson Community Foundation
Grant Application
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Name of Entity Requesting Funds *
Address *
City *
State *
Zip Code *
Phone Number *
Email Address *
Your copy of this completed application will be sent to this address.
Describe the Entity *
Legal composition, directors and staff, purpose, history
Amount of money requested *
When will the funds be needed? *
MM
/
DD
/
YYYY
Provide a detailed explanation of how the funds will be used. You may upload supporting information or documents that may be helpful to the directors as they consider this request. *
Will you be uploading additional supporting documents to explain how the funds will be used? *
How will the Jefferson area benefit if your organization is awarded a grant? *
How many individuals do you estimate will benefit from your project on an annual basis? *
Describe the sources of other funds available, or being sought, to complete this project. *
Will you be uploading additional supporting financial documents? *
These could include financial statements for the last two years and year-to-date statements for the current year. These statements should consist of balance sheets for each of the three periods and operating statements showing actual results against budget for each period. Also show your sources of revenue.
Person Representing Entity *
I hereby certify that all information submitted with this application is true and correct to the best of my knowledge.
By typing your name, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this Agreement. By typing your name using any device, means or action, you consent to the legally binding terms and conditions of this Agreement. You further agree that your signature on this document is as valid as if you signed the document in writing. You also agree that no certification authority or other third party verification is necessary to validate your signature, and that the lack of such certification or third party verification will not in any way affect the enforceability of your signature or any resulting agreement between you and the Jefferson Community Foundation.
Signature and Title *
You understand and accept the conditions of this agreement and sign electronically.
Signature and Title of Supervisor, if appropriate
You understand and accept the conditions of this agreement and sign electronically.
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