Fillable Wells Fargo Philanthropic Services Grant Application Instructions (Wells Fargo)

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Wells Fargo Philanthropic Services Grant Application Instructions (Wells Fargo)

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Wells Fargo Philanthropic Services
Grant Application Instructions
Wells Fargo Philanthropic Services provides grant administration services for various
foundations. Guidelines, deadlines, and submission requirements are unique to each
foundation.
Please visit our website wellsfargo.com/privatefoundationgrants for specific details prior to
applying for a grant.
General criteria and limitations
Qualifying tax-exempt 501(c)(3) organizations are eligible to apply for grants consistent
with the purpose of the foundation to which they are applying.
Applicants may be required to submit additional information regarding their current tax-
exempt status if they are otherwise deemed eligible to receive grant funds.
Applicants that have previously received funds must be in good standing with respect to
any required status reports or other conditions imposed before submitting a new
proposal.
Instructions
All form fields are required unless marked as optional.
Use correct grammar and do not use all capital letters.
Format dollar amounts with a dollar sign and comma where appropriate. Do not include
cents. Example: $5,000
Do not submit attachments unless specifically requested.
Return this application via email to grantadministration@wellsfargo.com.
After you apply
Applicants will receive an email acknowledging receipt of their application.
If a grant is approved, the grantee may be required to sign and return a grant agreement
prior to receiving funds.
Progress reports and completion reports may also be required for approved grants.
Contact Us
Questions? Visit our website wellsfargo.com/privatefoundationgrants or contact us at
grantadministration@wellsfargo.com or 1-888-234-1999.
Updated 6/13/2013
Wells Fargo Philanthropic Services
Grant Application Form
1. Name of foundation from which you are seeking funds
Tax exempt status
2. Federal taxpayer identification number
3. Organization name per Internal Revenue Service records
Note: If any grant funds awarded would be used by an entity other than the tax-exempt organization
identified above, describe the relationship between such other entities and the identified organization.
4. Fiscal agent or sponsor
5. Tax exemption date
6. Entity type
Note: Enter the Internal Revenue Code sections describing the organization's tax-exempt status as
recognized by the Internal Revenue Service. For example, IRC Sections 501(c)(3) and 509(a)(2).
7. Additional exemption status comments (optional)
Contact information
8. Organization name
Note: Enter the full legal name of the organization to be contacted regarding this application. If this
name differs from the name on file with the IRS for the taxpayer identification number provided at the
beginning of this application, please explain (e.g., "applicant organization is one of multiple chapters
covered under a group tax exemption for the taxpayer ID provided").
9. Also Known As/Doing Business As
Note: If the organization is known by other names, enter each such name below.
10. Mailing address
11. Physical address (if different from mailing address)
12. Main phone number
13. Website
14. Email address for general inquiries
Primary request contact
15. Prefix
16. First
17. Middle initial (optional)
18. Last
19. Title
20. Email
21. Office phone
Request summary
22. Requested amount
23. Type of support (choose one)
Building Repair & Improvement
Capital Fund Support
Capital Purchases
Challenge Grant
Endowment
General Operating Support
Project / Program Support
24. Request/project title
Note: Describe specific purposes for which any grant funds awarded from this foundation will be used
(e.g., specific equipment, overall project funding, etc.).Limited to 1,000 characters.
25. Request summary
Note: Why do you believe a grant to your organization would further this foundation's mission and
priorities of our foundation? Limited to 1,000 characters.
26. Common goals
Demographics
27. Program area (choose one)
Arts, Culture, and Humanities
Education
Environment/Animals
Health
Human Services
International/Foreign Affairs
Public/Society Benefit
Religion
28. Geographic area served
29. Population served (choose one)
General Population - General/Unspecified
Poor, Economically Disadvantaged,
Indigent
Homeless
Unemployed, Underemployed, Dislocated
Health or Disability - General/Unspecified
People/Families of People with Health
Conditions
Other Health / Disability
Alcohol, Drug, Substance Abusers
At-Risk Populations
Elderly and/or Disabled
Families
Immigrants, Newcomers, Refugees
LGBTQ
Offenders, Ex-Offenders
Victims
Other Named Groups
30. Age group served (choose one)
General/Unspecified
Combination of Children's Ages
Infant to Preschool Age (0-5 years)
Grade School Age (6-13 years)
High School Age (14-18 years)
Adults (18+ years)
Seniors (65+ years)
31.
Gender served (choose one)
General/Unspecified
Males Only
Females Only
32.
Demographics comments (optional)
Project detail
33.
Describe the objectives of the project or program to be funded.
Note: Limited to 1,000 characters.
34. Describe the implementation plan for the project or program. Include at least three specific
actions your organization will take in order to achieve results.
Note: Limited to 1,000 characters.
35.
What criteria does (or will) your organization use to measure the success of the project or
program?
Example: Of the 400+ persons we serve/reach, we anticipate that approximately 200 will benefit in
the manner described below, whereas without our program no more than 50 might reasonably have
been expected to achieve the same result. This expectation is based on statistics from prior similar
projects we have successfully conducted. Note: Limited to 1,000 characters.
36.
Collaboration
Note: Briefly describe any formal or informal collaborative ventures your organization has established
(or will establish) with other entities serving similar purposes that may be relevant to this grant
request. Limited to 1,000 characters.
37.
Background
Note: If this grant request relates to an ongoing project or program, how long has the project or
program been operating? Limited to 1,000 characters.
38.
Project start date
Note: If a grant is awarded, when does your organization anticipate being able to begin using the
funds for the requested purpose?
39. Project end date
Note: If a grant is awarded, when would the requested funds likely be exhausted?
40. Timeline
Note: Provide any other relevant dates relating to the project or program for which grant funds would
be used (milestones, interim check-ins, etc). Limited to 1,000 characters.
Project finances
41.
Project budget total in U.S. dollars
42.
Project budget detail
Note: Provide a concise budget for the project listing major expense categories (if requesting general
operating support, enter "not applicable").
43. Other project funding
Note: List other sources that may fund this project. Include other pending grant requests, providing
entity name, amount requested, and current status of each. If these sources do not fully fund the
project, what other sources of funding will your organization pursue?
Organization details
44.
Organization type (choose one)
Arts, Culture, and Humanities
Education
Environment/Animals
Health
Human Services
International/Foreign Affairs
Public/Society Benefit
Religion
Note: Select the classification that best describes your organization's primary purpose.
45.
Mission
Note: Briefly summarize your organization's current mission. Limited to 1,000 characters.
46.
Board members
Note: List your organization's current board members, officers, and trustees, as applicable. Example:
Board Member's Full Name, Title at Your Organization, Name of Other Employer & Professional Title (if
applicable)
47.
Number of paid staff, full-time
48.
Number of paid staff, part-time
49.
Number of volunteers
Organization finances
Current fiscal year finances
50.
Total annual budget
51.
Organization budget detail
Note: Provide a brief budget for your current fiscal year that breaks down the above overall total by
category. (Suggested categories: program services, salaries, fundraising, capital improvements,
equipment, recruiting, etc.).One budget item per line.
52.
Budget changes
Note: Summarize any significant changes in your current year budget since initially established.
53.
What percentage of your budget is allocated to administrative expenses?
Prior fiscal year finances
Note: Complete the following sections using information included on your organization's most recently
filed tax return. Enter "N/A" for items that are not applicable. If your organization does not file a tax return,
use information from its most recent financial statement.
54. For fiscal year ending
55.
If your organization did not file a tax return for its prior fiscal year, explain why
56.
Revenue
a.
Individual donations
b.
Grants from related organizations
c.
Government grants or contributions
d.
Program service revenue
e.
Investment income
f.
Other revenue
g.
Total revenue
$0
57. Expenses
a. Program services
b. Administration
c. Fundraising
d. Other expenses
e. Total expenses
f. Revenue less expenses
58. Net assets or fund balances
a. Total assets
b. Total liabilities
c. Net assets or fund balances
59. Additional finance-related comments (optional)
Note: Limited to 1,000 characters.
Certification
I certify that the information contained in this grant application is true and correct to the
best of my knowledge.
Name
Title
Date
$0
$0
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Wells Fargo Philanthropic Services Grant Application Instructions (Wells Fargo)

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Completed 20 November 2021

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