Apply – Bell Community Foundation

Grant Application

Contact Info

Agency Name

Phone

Street Address

City

State

Zip Code

Physical Address (if different from above)

City

State

Zip Code

Agency Website

Agency TIN

Agency Director & Title

Phone

Agency Board Chair

Phone

Organization Information

Agency Mission Statement

Agency Vision Statement (if applicable)

Brief Overview of Organization

Demographic Breakdown of Population Served (Ethnicity, Age, Gender)

# Full-Time Staff

# Part-Time Staff

# of Volunteers (approx.)

Current Operating Budget

Grant Request

Project/Program

Program Goal

Geographic Area Served

# of Unduplicated Clients Served

Implementation Timeline

Request Total

Grant Details

Please provide information on:
1. The main issues/problems this grant request addresses & details on why & how you address these issues.
2. Proposal details.
3. Evaluation & performance measures.

Narrative:

Please provide a story that illustrates the impact of your proposal.

Story:

Please describe your plans to support the proposal after the term of this grant.

Long-Term Plans:

I certify that my answers are complete & true to the best of my knowledge