NEW PROGRAMSVENTURE GRANT APPLICATION（四）.docVIP

A COMPLETE APPLICATION INCLUDES 5 PACKETS THAT CONTAIN THE FOLLOWING: COVER SHEET Use the attached cover sheet PROJECT BUDGET CURRENT BOARD APPROVED LOCAL ORGANIZATION BUDGET PROPOSAL (no more than 3 pages): Your concise proposal must contain the following information clearly identified with headings: Brief history and explanation of mission of organization. Project description. The human service need in the Bemidji area being addressed. Geographic area that will benefit from the project. Specific target population and estimate of the number of people affected. Expected outcomes of this project. Evaluation procedure description (the method for measuring expected outcomes.) Future funding sources for the project. Implementation schedule for the project (specific dates). Plan for acknowledging United Way as a funding source. The following is the preferred language for press statements: “This project was made possible in part through funding from the United Way of Bemidji Area Venture Grant Program. VERIFICATION OF 501(c)(3) or GOVERNMENT STATUS Please include a copy of your official 501(c)(3) verification form UNITED WAY OF BEMIDJI AREA VENTURE GRANT APPLICATION COVER SHEET Date of Application Name of Organization Mailing Address Contact Person, Title Phone Number E-mail Project Title Dollar Amount Requested from United Way Project Dates Total Project Budget Amount Annual Agency or Departmental Operating Budget Other Sources of Revenue for the Project (Please list confirmed and pending sources) We understand that a Grant Summary Report must be submitted to the United Way within 30 days of the conclusion of the project or by December 31st of the funding year, whichever is first. SIGNATURES (at least two of the following are required) Contact Person________________________________________________ Date _________________ Chief Professional Officer ___