CHIditarod Grant Letter of Intent
Form must be submitted by 11:59pm, central time, on July 1, 2019

See this URL for further details and requirements: http://www.chiditarod.org/grants/

Questions? E-mail Foundation Secretary Jennifer Carroll at jen@chiditarod.org

Are you applying directly or nominating an organization? *
General Information
Organization Name *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Website *
Your answer
Phone *
Your answer
Fax
Your answer
Mission *
Please BRIEFLY state the organization’s mission, the communities in which you work, and your primary program activities:
Your answer
Geographic areas served by the organization *
What geographic areas do you serve? (neighborhoods, cities, counties, states, etc)
Your answer
Number of people served *
Please estimate how many people your organization serves on an annual basis.
Your answer
Contact Person for this grant
Name *
Your answer
Title *
Your answer
Email *
Your answer
Phone *
Your answer
Executive Director or Organization Lead
Name *
Your answer
Title *
Your answer
Email *
Your answer
Phone *
Your answer
Organization Details
Tax ID Number *
Your organization's Tax ID number
Your answer
Organization’s annual operating budget *
Your answer
Organization’s actual income for last completed fiscal year *
Your answer
Organization’s actual expenses for last completed fiscal year *
Your answer
Organization’s surplus or deficit at the end of last completed fiscal year *
Your answer
Tax-Exempt Status *
When did this organization gain 501(c)(3) tax-exemption status?
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Name of fiscal sponsor, if applicable.
Your answer
Tax ID of fiscal sponsor, if applicable.
Your answer
Proposed Project
Type of project proposed *
Please select the category that best describes the nature of the project that you would like to support with a grant from the CHIditarod Foundation.
Project description
Please provide a very brief description of your proposed project.
Your answer
Who is eligible to participate in this program?
Your answer
Is this program already operational?
What is the actual or proposed start date of this program?
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DD
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About how many unique individuals are served by this program (or will be served once it is operational) on a monthly basis?
Your answer
Program's operating budget
Please provide the total operating budget of the specific project or program you hope to apply the grant to, if different than your organizations overall operating budget.
Your answer
What neighborhood(s) will be served by this program?
Your answer
This project represents (or will represent) what percent of the organizations annual budget?
Your answer
What percent of operational costs for this program will a grant from the CHIditarod Foundation be able to cover?
Your answer
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