THE JUNIOR LEAGUE OF SIOUX CITY, INC.

MILDRED ANDERSON COMMUNITY GRANTS APPLICATION

Applications should be typed and up to 3 pages in length (not including attachments).

Submit three copies by January 15 to: Junior League of Sioux City Grant Program

c/o Siouxland Community Foundation, 505 Fifth Street, Suite 412, Sioux City, Iowa51101

Organization:
Address:
Telephone: / *501(c)(3) IRS letter? / Yes / No
Name of Contact Person:
Address:
Telephone: / Email:
Project Name:
Grant Amount Requested: / Total Project Cost:
Amount Committed for Project to date: / #of volunteers involved in project:

Has the organization received a Mildred Anderson grant within the previous year?(June 2012 to May 2013) Yes No

Narrative Proposal Content Attach page(s) to provide the following information:

  1. Brief background of organization and mission.
  2. Describe the community need that the project is addressing; substantiate with evidence of need if available.
  3. Describe the proposed project and how grant funds requested will assist organization in meeting the community need.
  4. Who is the target population that will benefit from this project? How many people will be served? Describe how the Siouxland community will benefit from this project.
  5. Describe the volunteer component of the project including the roles of the volunteers. State the number of volunteers that will be involved with the project and identify how many have been recruited to date. (Mildred Anderson Community Grants are awarded to promote volunteerism, but do not provide Junior League volunteers.)
  6. Describe how the project will be evaluated and measured for success.
  7. Outline of project timeline.
  8. Line item budget for the project, including total project cost (attach estimates and/or quotes).
  9. If additional funding is needed for completion of this project, provide plan for raising the balance needed?
  10. Describe how your organization will recognize the Junior League of Sioux City if grant is awarded (i.e. plaque, press release, press conference, signage, etc.).

Please include a list containing the names and addresses of your organization’s board of directors or organizational leadership.

*Include a current copy of letter from IRS indicating that your organization is tax-exempt under Section 501(c)(3) of the Internal Revenue Code.

Note: If your organization is not a 501(c)(3), attach a Fiscal Sponsorship Agreement form that

has been completedand signed by the sponsoring 501(c)(3) nonprofit organization.

Form available at

Signature of Organization Representative
Title / Date

Revised: 8/12