Fillable ENGELSTAD FOUNDATION GRANT APPLICATION FORM Please be sure

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ENGELSTAD FOUNDATION GRANT APPLICATION FORM Please be sure

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ENGELSTAD FOUNDATION
GRANT APPLICATION FORM
Please be sure to fill out the application completely, all fields are required. Your
organization’s total grant submission can be up to a maximum of 10 pages. The page
count includes this application and your organizational budget. Please feel free to
attach additional pages to your application keeping the 10-page limit in mind.
Note: Any information outside of the fillable fields will not be included in your application.
If you have more information than will fit into the preset fields, please add additional
pages to this application.
Background Information:
Program or project title:
Or
ganization: _____
Address:
Ci
ty, State, Zip: _______________________________________________________________
Phone: Fax:
E-mail: Website:
Cont
act person: Title:
Did your organization explore the Nevada GrantLab opportunity on the Engels
tad Foundation
website? [ ] Yes [ ] No
If yes, did you register as a partner? How was your experience?
If no, why didn’t your organization take advantage of this opportunity?
Information about the Request:
Date of application: Amount Requested:
Type
of Support (please check):
[ ]Project [ ]General Operating [ ]Capacity Building [ ]Technical Assistance [ ]Emergency
What geographic area will be served?
Organization name ___________________________
2 |Engelstad Foundation Grant Application
What is the approximate number of people served by this project? _________________
What is the period of time covered by the project? _______________________
Organizational Information:
How long has the organization been in existence? _____
How many people are served annually overall? ______________________________________
Number of paid staff: Full-time _______________ Part-time _______________________
Number of volunteers involved in your organization ___________________________________
What percentage of the people you serve use your services multiple times? ________________
____________________________________________________________________________
Are there other non-profit agencies that your organization is partnered with? Please list:
How often does your board meet? ________________________________________
Please list the members of the Board of Directors:
Please list the names and titles of the leadership of your organization:
Organization name ___________________________
3 |Engelstad Foundation Grant Application
What is your organization’s mission statement?
Financial Information:
Total income of organization (most recent fiscal year):
Total expenses of organization (most recent fiscal year):
I
f your application is for a project:
Total expenses budgeted for the project:
Amount raised for the project so far:
P
lease list the other funding sources with the amount funded per source.
What is the end goal of the possible grant? What do you hope to achieve?
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Completed 7 September 2021

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