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Community Impact Grant Application

Please read grant guidelines HERE.

We recommend that you type into another program such as Microsoft Word to save your text and then copy and paste into the application.

Step 1 of 2

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Name*
Organization's Name
Phone*
Email*
Address*
Street Address City State ZIP Code
Program Details
Amount Requested*
(X,XXX.XX) No $ required.
If the request is partially funded, will the project/program still be viable?*
- Yes
- No
Total Program Budget*
(X,XXX.XX) No $ required.
Program Budget Summary*
Please provide a detailed summary of how the funds for your project or program will be allocated, emphasizing how and where the funds granted from the Community Impact grant will be utilized. Bullet points are fine. Be specific.
Projected Program Start Date*
MM slash DD slash YYYY
Program Title*
Type of Request*
- General Support
- Capital Expenditures
- Program Support
- Technical Assistance
- Other
Please fill in the type of request*
What is the primary purpose of the request?*
- Education
- Human Services
- Environmental Improvement
- Medical & Hospice Care
- Art & Cultural Activities
- Economic Development
What counties will this program serve?*
- Carroll
- Haralson
- Heard
Project/Program Narrative*
Describe the problem/opportunity that the grant will address in a brief narrative. Limit your response to a maximum of 1500 words. Please include the following in your explanation: * Specifically, what is the problem or opportunity to be addressed and how will the grant address the problem/opportunity? * How would you use the Foundation's funds to address this problem/opportunity? * What are the goals/objectives of the program? How will they be measured? * Who are the targeted groups that will benefit?. * Identify in your narrative other collaborations or partnerships with other groups to accomplish your goal(s).
Are the beneficiaries of the program required to do anything specific?*
ex: attend religious services/training or pay a fee to participate in the program?
- No
- Yes
If yes, please describe below*
Organizational Structure
Do you have 501(c)(3) certification?*
- No
- Yes
- Not Applicable
Please note date 501(c)(3) certification acquired
MM slash DD slash YYYY
Please attach copy of 501(c)(3) certification letter
Max. file size: 20 MB.
Federal Tax #ID*
Date Incorporated*
MM slash DD slash YYYY
Describe the mission and summarize the history of the organization. What are the organization's main activities or programs?*
Limit your response to 1,500 words.
Please attach a list of the current Board of Directors, including their address and occupations:*
Number of paid employees*
Number of volunteers*
Financial Information
What is the total operating budget of your organization?*
If awarded, what percentage of your budget will consist of Community Impact funds?*
What other sources of financial support will be used to fund this project?*

Save and Continue Later

Please review your form below before pressing the Submit button at the bottom of the page. To make changes, press the Previous button.
Please review your form below before pressing the Submit button at the bottom of the page. To make changes, press the Previous button.
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Phone
This field is for validation purposes and should be left unchanged.

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