Granville County
APPLICATION FOR OUTSIDE AGENCY FUNDS
FISCAL YEAR 2016-2017
Please return the original and one (1) copy of this form by
5:00 P.M., March 11, 2016 to:
Granville County
County Finance Director’s Office
P O Box 1286
Oxford, NC 27565
Request Submitted By:
______
Agency Name
______
Agency Street Address
______
City, State and Zip
Email address
Funding Received from Granville County, FY 2015-2016 $ ______
Amount of Funding Requested, FY 2016-2017 $ ______
(If amount requested for fiscal year 2016-2017 is greater than fiscal year 2015-2016 amount, you must submit the service expansion form as the cover page of your request)
______
Agency Contact (Please Print) Agency Contact Signature
______
Title Telephone
Granville County Finance Department Use Only
Date Request Received by Granville County: ______
Your 2016-2017 Budget funding request letter should include the following information:
1. Describe the mission and/or programs of your organization.
2. What Granville County community need is the agency addressing in this request?
3. How will the funds be used to help the agency accomplish its mission? Please include, when possible, number of people served; geographical area served; and other funding sources you receive.
Attachments: Please attach the following items or provide a brief explanation why they cannot be provided.
1. A list of the Board of Directors, permanent staff members, and key volunteers.
2. Copy of the tax status determination letter from the IRS.
3. Copy of the most recent independent audit of the agency. If your agency/organization is not audited, please provide a copy of the latest year-end financial report.
4. Provide documentation showing that the agency/organizations finance officer/treasurer is bonded at an amount not less than two times the funding level requested.
PLEASE NOTE:
The budget for fiscal year 2016-2017 will prove to be a challenge for the Board of Commissioners and County Administration Staff. If your organization was not a funded agency in the County’s fiscal year 2015-2016 budget or you were funded in 2015-2016 and are requesting funds in excess of the current funding level, you will need to submit your request as a service expansion. Please be sure to include the service expansion form as the coversheet for your request due by March 11, 2016. (See last page)
Agencies that have received funding in the past, and are not requesting additional funding, should send their proposed Continuation Budget request to the County Finance Director’s office by March 11, 2016. Please include supporting information with your requests. Requests without supporting documentation may not be included in the continuation budget for fiscal year 2016-2017.
Any attachments submitted with your request (other than your audit or financial statement) will be photo copied for the budget workbooks, permanently bound documents submitted in support of your request may not be included in the commissioner’s budget materials.
Outside Agency Funding
Service Expansion Request Cover Page
If your organization was not a funded agency in the County’s fiscal year 2015-2016 budget or you were funded in fiscal year 2015-2016 and are requesting funds in excess of the current funding level, you will need to submit your request as a service expansion. These requests are due by March 13th. You should include additional information to support the request. Any attachments submitted with your request will be photo copied for the budget workbooks, permanently bound documents submitted in support of your request may not be included in the commissioner’s budget materials.
Did your agency receive funding in fiscal year 2015-2016? Yes £ No £
Name of Agency/Organization: ______
Summary of Request and Justification: (Please provide a brief summary of your request in the space provided. Additional documentation should be attached to further explain and support your request).
Total Amount ofService Expansion
Request. / $