Grant2019

Please be sure to fill out the form completely. You cannot save this form and return to work on it again. We suggest you develop your budget and answers to the questions separately and then fill out the form.

Choose Type of Grant

Education

General

Name of Organization *

Sponsor Tax ID No *

Type of Entity *

Submit a copy of your EIN Letter of Determination (if you are a nonprofit) or your 4076C Government Entity Letter (if you are a government entity) Failure to include this attachment may result in disqualifying your application.

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Maximum upload size: 52.43MB

Mailing Address of Organization *

Mailing Address of Organization

City

State

Zip Code

Physical Address of Organization (if different than above)

City

State/Province

Zip/Postal

Name of Person Submitting Request *

Title of Person Submitting Request

Address of Submitter (if different than above)

City

State/Province

Zip/Postal

Contact Phone Number *

Contact Email (INCLUDE ONLY ONE EMAIL ADDRESS HERE) *

Grant Amount Requested. Minimum $2000 *

Total Budget for Project/Program

Project Title *

Date Project/Program will begin

County/Counties Project is Located in

Physical Address of Project (Be as specific as possible)

City

State

Zip Code

Please summarize the mission and activities of your organization.

Explain your proposal and why your organization is requesting this grant.

Outcomes you hope to achieve.

How you will spend the funds if a grant is approved by council board.

Other assistance

Support Requested

Subject Focus (Program Area)

Population Served

Project Budget

NON-REIMBURSABLE ITEMS: SALARY, RENT, FOOD, APPAREL, TRAVEL, MILEAGE
The Board reserves the right to reimburse items at their own discretion.

Project Budget

Budget Item (s)

Cost of Item (s)

$ Requested from RC&D

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Cost of Item (s)

$ Requested from RC&D

Budget Item (s)

Cost of Item (s)

Amount Requested from RC&D

Budget Item (s)

Cost of Item (s)

Amount Requested from RC&D

Budget Item (s)

Cost of Item (s)

Amount Requested from RC&D

Budget Item (s)

Cost of Item (s)

Amount Requested from RC&D

Project Begins

Project Ends --- Project must be completed by July 17, 2019

Grant Cycle: Open Enrollment Period: May 1, 2018-June 30, 2018.

Project approval and grant-training from Mid-South RC&D Council is required PRIOR to start of project/program.

A Cooperative Agreement must be signed upon approval. Photos before and after are required. Grants are paid on a reimbursement basis after all paid receipts, cancelled checks, and all required documentation is provided to the council by the grantee. Funds must be spent and documentation returned to Mid-South RCD by July 17, 2019.

NOTE: A copy of IRS Letter of Determination for 501c3 verification of TIN# (Tax ID Number) is required. Alternately, please include your 4076C Letter if you are a Government entity.

APPLICATION REQUEST MUST BE approved by the Mid-South RC&D Council Board of Directors prior to start of project/program.

All grantees agree to give Mid-South RC&D Council credit on all press releases and publications.

Add any additional documentation you would like to include (up to 10 total files)

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Maximum upload size: 52.43MB

Responsible Party Signature *

Title *

Date of Application

All programs and services of RC&D are offered on a non-discriminatory basis, without regards to race color, national origin, sex, religion, age, disability, political belief, sexual orientation, or marital or family status (DOC revised 2017)

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Project Budget