SAMPLE GRANTOR PAPER The document is an actual Grantor Request for Proposal identified by an Assistance League Chapter.

ANY LOGO

ANY FOUNDATION COMMUNITY GRANTS for FISCAL YEAR ENDING 6/30/12 Any Address telephone contact (Any Name): Any Phone Number email: Any Email website: Any Website

Any Name is soliciting Community Grant applications for the year 2012/2013. In order to be eligible, organizations must have a tax-exempt 501(c)3 IRS status or be publicly supported. The program/project must directly benefit an identified need in the Any Region. Grant requests from $500 to $2,500 will be considered.

A copy of the application form is attached. Application packages may be downloaded online at Any Website. Completed applications must be mailed to: Any City Foundation Grants Any Address Any City, State, Zip Code or hand-delivered to: Any Name ATTN: Any Foundation Grants Any Address

Funds must be applied to a specific program/project. Only one program/project will be considered per applicant.

Any (Any Name) Foundation Trustee or Member of the Any Organization having a financial interest in, or employed by, a grant applicant must disclose such interest prior to participating in the grant application process.

The deadline for receipt of application is Friday, March 9, 2012

Grants will be awarded at a special luncheon meeting of the Any Organization on Monday, May 7th at Any Hotel in Downtown Any City. Grant recipients are expected to attend the luncheon and provide up to three photographs for a PowerPoint presentation. Any FOUNDATION

COMMUNITY GRANTS APPLICATION for FISCAL YEAR ENDING 6/30/12

Any Address telephone contact (Any Name): Any Phone Number email: Any Email website: Any Website

Name of Organization: ___________________________________________________ Address: ______________________________________________________________ ______________________________________________________________ Telephone: ____________________________________________________________ Chairman or President of Board: ___________________________________________ Chief Executive Officer (CEO): ____________________________________________ Contact Person if other than CEO: _________________________________________ Telephone: _________________ Email Address: _____________________________

Use additional space, as required, for the following: I. II. Purpose of Organization (including a brief history) Grant Amount Requested: $____________________ Total Cost of Program / Project: $_____________________ III. Please attach: a. List of Board Members and Affiliations b. Brief Summary of CEOs Education, Background and Experience c. Most Recent Annual Report / Financial Statement d. Most Recent Approved Budget e. Tax Exemption Determination Letter or Explanation if Missing

IV.

Please attach a brief description of the program/project for which you are requesting support, including the following information: a. Description of the project, including a statement identifying the use of the funds

b. Project budget c. Explanation of need to be addressed by the project d. How the program/project will benefit the community e. Project timeline f. Description of how the success of the project will be measured

g. Name of Any Organization Liaison h. Ways in which Any Organization members might be involved and/or participate in the program/project i. How will the Any Organization be recognized for the contribution