Fillable Community Impact Funds Applying for Charitable Support (Swinomish Indian Tribal Community)

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Community Impact Funds Applying for Charitable Support (Swinomish Indian Tribal Community)

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swinomish-nsn.govSwinomish Community Impact Funds Page 1 of 4
1. Community Impact Funds Applicaon. Found on pages 3 and 4, this should be the rst
document in your applicaon packet. It must be lled out completely and include a signature.
2. Proposal Summary. Summarize in a short paragraph the purpose of your organizaon. Briey
describe why you are requesng a community impact grant, what outcomes you hope to
achieve, and how funds would be spent if a grant is received.
3. Narrave. The narrave must include:
• Background informaon describing the work of your organizaon. Illustrate the needs
or problems your organizaon works to address and the populaon it serves, including
geographic locaon, socio-economic status, race, ethnicity, gender, and age group.
List current programs and accomplishments, as well as the number of paid full-me,
part-me, and volunteer sta. Describe your organizaon’s relaonships with other
organizaons, both formal and informal, working to meet the same needs or provide
similar services and explain how you dier from these other organizaons.
• Your funding request. If applying for general operang support, briey describe how
this grant would be used. If your request is for a specic project, explain its primary
purpose and the need or problem you are seeking to address. Include names and tles
of the individuals who will direct the project. Include the ancipated length of the
project and how it contributes to your organizaon’s overall mission.
• An evaluaon of how you will measure the eecveness of your acvies. Describe
your criteria for a successful program and the results you expect to achieve by the end
of the funding period.
4. Operang Expenses. A report specic to the project.
5. Current Funding Sources. List other sources and amounts already secured for your project.
All elds are required to be considered for review
Community Impact Funds
Applying for Charitable Support
Thank you for applying with the Swinomish Indian Tribal Community on behalf of your 501(c)(3) status
organizaon. The Tribe is commied to helping grow and improve our local community in the areas of arts
and culture; educaon and youth services; the environment; health care; public safety; and social services.
IMPORTANT: Community impact funds are limited to organizaons operang within the state of Washington only.
Fund distribuons are made once a year. Applicaons and supplemental aachments are due April 14 by 6PM.
COMMUNITY IMPACT FUNDS APPLICATION CHECKLIST
swinomish-nsn.govSwinomish Community Impact Funds Page 2 of 4
6. Board/Commissioner and Aliaons. A list of your board of directors, council, commissioners,
or ocers and their aliaons. This adds credibility to your project, as we want adequate
oversight with credible community members.
7. IRS Leer with 501 (c)(3) or Government/School Designaon. Submit a copy of the leer
from the Internal Revenue Service where designaon of 501 (c)(3) status for your organizaon
is menoned.
All elds are required to be considered for review
Community Impact Funds
Applying for Charitable Support
To save paper, please print mul-page documents double sided if possible. Please note that submied materials,
including photos and documents, will not be returned.
Mail your completed applicaon packet, which must be postmarked on or before April 14, to:
Swinomish Indian Tribal Community
Aenon: Community Impact Funds
11406 Moorage Way
La Conner, WA 98257
If your applicaon is approved and you receive a contribuon from the Swinomish Indian Tribal Community,
we would appreciate a follow-up report upon the compleon of your project for our annual community impact
funds report and website. Please email your follow-up report and project photographs to Sarah Holmstrom at
sholmstrom@swinomish.nsn.gov.
SUBMITTING YOUR APPLICATION PACKET
swinomish-nsn.govSwinomish Community Impact Funds Page 3 of 4
All elds are required to be considered for review
Community Impact Funds
Grant Applicaon
Chief Execuve Ocer (CEO) or President
If dierent than name listed on the IRS exempon leer,
please explain relaonship to exempt organizaon
Applicaon contact (if dierent than CEO/President)
Contact person’s tle
Legal name of organizaon
Physical address
Mailing address (if dierent from above)
City
City
State
State
Zip Code
Zip Code
Employer Idencaon Number (EIN)
Contact person’s telephone
Contact person’s email address
Organizaon’s website address
Number of employees
Number of volunteers
Approximate number of persons served annually
Age range of persons servedGeographic area served
Principal purpose and service of your organizaon
CEO/President’s email address
Organizaon’s main or CEO/President telephone
CONFIDENTIAL
swinomish-nsn.govSwinomish Community Impact Funds Page 4 of 4
All elds are required to be considered for review
Community Impact Funds
Grant Applicaon
May
June
July
August
September
October
November
December
Specic purpose for which funds are requested
Amount requested Period of me in which funds will be spent
Does your organizaon receive support from the United Way or other federated funds?
If yes, aach a list of which ones.
Does your organizaon have 501(c)(3) status? If yes, include a copy of IRS leer stang your
organizaon’s non-prot status. If no, include the name of sponsoring organizaon with your
organizaon name at top.
Year-round
January
March
February
April
Signature date CEO/President or representave’s signature
Yes No
Yes No
Monday through Friday
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Saturday
Sundays
Organizaon’s annual months of operaon Organizaon’s weekly days of operaon Times
CONFIDENTIAL
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Community Impact Funds Applying for Charitable Support (Swinomish Indian Tribal Community)

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Completed 27 January 2021

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