Fillable Grant Form FINAL 2018 Fillable Distributed (CITY OF HOPEWELL)

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Grant Form FINAL 2018 Fillable Distributed (CITY OF HOPEWELL)

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City of Hopewell
Community Agency Funding Grant Application
For the fiscal year July 1, 2017 – June 30, 2018 (FY 2018)
Organization Name:
Contact Name:
Title
Address
Phone
Email:
Organization Officer’s Names
Title
Phone
External Auditor:
Address:
Phone: Email:
Service Category
Arts & Cultural Crisis Intervention Educational/Literary
Econ. Development/Business Assistance Housing/Homeless Senior Services
Services to Disabled Youth/Children’s Services
Other (Describe)
Funded services will be provided: Regionally in the City of Hopewell
Organization’s fiscal year (e.g. July 1 – June 30)
Clients Served:
Time Period
Total No. of Clients Served
No. of Hopewell
Residents Served
2017 Fiscal Year
2016 Fiscal Year
2015 Fiscal Year
Total Annual Operating Budget:
FY 2018 FUNDING REQUEST FROM THE CITY OF HOPEWELL $
City of Hopewell
Community Agency Funding Grant Application
For the fiscal year July 1, 2017 – June 30, 2018 (FY 2018)
If additional space is needed, please modify as necessary or retype the page to suit your needs.
Please be sure to answer all questions. Additional copies of this document are available at
www.hopewellva.gov
1
Please define your organization’s mission:
2.
Please provide a description of the scope of services you offer or intend to offer the
citizens of the City of Hopewell
3.
Define your objectives, service targets, and action plan and how that relates to or helps
advance the City’s Strategic Plan for this application funding period (7/1/16 – 6/30/17).
Include current and new programs and initiatives, and target dates for new services.
4.
Please provide a detailed breakdown of how the funds requested from the City of
Hopewell will be use.
5.
If you received funding from the City in the past year, how were those funds used?
6.
If your request for this fiscal year is larger than for last year, please explain the reason
for the increase.
7.
What other matching funds are you requesting in addition to this request (e.g. other
localities, private donations, state funds, etc.)
8.
What are the organization’s three-to-five year goals, and what structure do you have in
place to achieve those goals?
City of Hopewell
Community Agency Funding Grant Application
For the fiscal year July 1, 2017 – June 30, 2018 (FY 2018)
9
If your request for funding is denied, or if you are awarded an amount less than your
requested amount, what impact will the denial have on your organization and on
Hopewell citizens?
10
Is your organization currently a participate of the Guide-Star© Exchange directory
Yes No
11
If your answer to question 10 was “yes”, please select your level of participation:
Participant only Bronze Silver Gold
12
If your organization is awarded the requested amount, or any amount, we ask that you
advise the City through its City Council how those funds were used.
Checklist
Please be sure to include one copy of the following in your application packet:
Application form(s)
501(C)(3) or other designation as a not-for-profit organization, as defined by the
Internal Revenue Code
Articles of Incorporation
Bylaws
List of current Board of Directors (names, addresses, phone, email)
Audited Financial Statements – Include a copy of your audited financial statements for
the most recent year available (if older than last year, please provide justification).
The audit report must include an opinion on the effectiveness of your organization’s
system of internal controls and on compliance with your organization’s bylaws and
with applicable laws, rules and regulations; yellow book audit standard text is
sufficient.
Current Operating Budget
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Grant Form FINAL 2018 Fillable Distributed (CITY OF HOPEWELL)

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Completed 14 July 2020

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