Grants 2018 Reallocated Fund Application Only Grant Application for 2018 Funds If you are human, leave this field blank. 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 * Nonprofit Government 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. Drop a file here or click to upload Choose File Maximum upload size: 52.43MB Mailing Address of Organization * Mailing Address of Organization Mailing Address of Organization Mailing Address of Organization City City State Alabama Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State Zip Code Zip Code Physical Address of Organization (if different than above) Physical Address of Organization (if different than above) Physical Address of Organization (if different than above) Physical Address of Organization (if different than above) City City State/Province Alabama Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Name of Person Submitting Request * Title of Person Submitting Request Address of Submitter (if different than above) Address of Submitter (if different than above) Address of Submitter (if different than above) Address of Submitter (if different than above) City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal 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) Physical Address of Project (Be as specific as possible) Physical Address of Project (Be as specific as possible) Physical Address of Project (Be as specific as possible) City City State Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State Zip Code 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 Budget Item (s) 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, 2018 Grant Cycle: Project Beginning Date: REALLOCATED FUNDS MUST BE SPENT AND REQUIRED DOCUMENTATION RETURNED BY July 17, 2018. Grants are paid on a reimbursement basis after required documentation is received. If there are REALLOCATED FUNDS, your application will be reviewed for consideration. 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, 2018. 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) Drop a file here or click to upload Choose File 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)
