CITY OF
HARRISONBURG
2020-2021
CIVIC AND COMMUNITY ORGANIZATIONS
FUNDING APPLICATION PACKET
APPLICATIONS DUE BY
Thursday, January 30, 2020
5:00 P.M.
AT
Office of City Manager
409 South Main Street
Harrisonburg, Virginia 22801
Phone: (540) 432-7701 Fax: (540) 432-7778
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GENERAL APPLICATION INFORMATION
1. This application should be used by any non-city organization or agency requesting funding from the
city’s General Fund budget. The purpose of this application is to assist the city in determining the
most effective use of city funds.
2. Applications are due in the Office of the City Manager, City Hall, 3
rd
Floor, 409 South Main Street,
Harrisonburg, Virginia, 22801, by 5:00 P.M. Thursday, January 30, 2020. This is not a postmark
deadline. If sending application via U.S. Mail, please allow sufficient time for delivery to ensure
that applications are RECEIVED by the deadline.
3. Private individuals are not eligible to submit project applications. Projects must benefit a group
of people and be administered by an agency, organization, or business (i.e., a legal entity).
4. The application must stand alone and will serve as the primary vehicle for applicants to provide
information on their request. However, applicants may also be asked to submit additional
information. Note: An appropriation of funds in one fiscal year does imply a commitment by the
City to provide funds in subsequent years.
5. The application evaluation will also now include a review committee. The review committee will
advance to the City Manager recommendations on which requests should be incorporated into the
City Manager’s budget. The City Manager will review and determine which recommendations to
include in the budget as is feasible based on financial constraints.
6. Leveraging of funds is an important consideration to the city in reviewing funding requests. While
pleased to contribute toward meritorious activities, the city prefers to invest where other funding
entities also contribute substantially to the cost.
7. Funding disbursements will be made on a quarterly basis. The quarterly disbursements will be
disbursed after notification from the agency is received by e-mail, letter, or fax. The city reserves the
right to adjust the quarterly payments should state or local budgetary circumstances so require.
8. Submit one (1) original copy of the application. Note: All attachments to the application must be
included in the original and all copies. You may send your application electronically in pdf format to
ande.banks@harrisonburgva.gov , regular mail, or hand delivery.
9. The application package must include the following:
i. IRS 501(C) Tax Exemption Determination Letter (if applicable)
ii. Current List of the Organizations Board of Directors (if applicable) indicating their
addresses, telephone numbers, and terms of appointment
iii. Organizations most recent audit
iv. Organizations written financial statement showing the sources of revenue and actual
expenditures for its current fiscal year
v. Evidence of insurance (listing of policies by type and coverage amount, indicating policy
end dates, or copies of certificates of insurance)
vi. State Corporation Commission Certificate and Evidence of Current Renewal (if
applicable)
1. IRS Form 990
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City of Harrisonburg
Funding Application Form
For Fiscal Year July 2020-June 2021
Name of Applicant:
Applicant Contact Information:
Project Manager Email
Phone Number Fax Number
Mailing Address:
Physical Address (if different than mailing address):
Amount of City Funds Requested: $
Total Annual Operating Budget: $ $ _________________________
Description of activity, including the design, goals, and benefits to be gained:
Explain why financial assistance from the City is necessary to provide these services, including
supporting statistical evidence and statements from authorities:
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Describe your prior experience in the same or similar activities as proposed, including years of
experience.
List other funding sources that are being sought and/or will be leveraged from the applicants
own resources along with this request for City funding:
Explain the effect upon these services if the City does not fund your request or if the award is
less than requested:
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How does this program create a unique and valuable impact in our City?
Explain how your activity contributes to fulfillment of the focus areas of the City Council’s 2039
Vision (Go to: www.harrisonburgva.gov/city-council-vision):
Based on your 2018 data, please provide the number of your clients whom reside within the City
of Harrisonburg and the total number of clients your agency serves:
____________________________________________ _____________________
Signature: Applicant Authorized Representative Date
click to sign
signature
click to edit
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SAMPLE BUDGET
Revenue
(List all Project Funding Sources, with HUD
first)
Amount
Anticipated Notification
Date
City General Funds
$12,000
7/1/13
Donations/Fund raising
$5,000
6/1/13
United Way Grant
$7,000
N/A
Fees for service
$21,250
7/1/13
Total
$45,250
Expenses (list)
Total
City Funds
Other Funds
Staff Wages
$20,000
$20,000
Staff Benefits
5,000
5,000
Staff Travel
1,500
1,500
Telephone
2,500
2,500
Copying
750
750
Training Supplies
9,500
6,000
3,000
Bus Passes
1,000
1,000
Child Care
5,000
5,000
Total
$45,250
$12,000
$33,250
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BUDGET FORM
Revenue
(List all Project Funding Sources)
Amount
Status
Received, applied for,
etc.
Anticipated
Notification Date
Total
Expenses (list)
Total
City Funds
Other Funds
Total
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