Pleasefilloutallrequiredfields (Markedwithan *). Forhelp

MatchingGrantApplication

Pleasefilloutallrequiredfields (markedwithan *). Forhelp, pleaserefertotheApplicationInstructionsincludedintheMatchingGrantProgramsGuidelinePacket.

InformationAboutYourGrouporOrganization

NameofGroup:* ______

City:* ______

Focus/Mission:* ______

GroupWebsite: ______

GroupEmail: ______

GroupPhone: ______

GroupAddress: ______

______

ContactPerson

Name:* ______

Email:* ______

Phone:* ______

MailingAddress:* ______

______

BasicInfoAboutThisMatchingGrantRequest

DateofthisGrantApplication: ______

ProjectName/Title:* ______

WhichMatchingGrantProgramAreYouApplyingFor?*

___ GrassrootsFundraisingMatchingGrant ___ RecurringDonorsMatchingGrant

Agreedmaximumamountforthismatchrequest: $ ______

FundraisingPeriodstartdate:* ______Enddate:* ______

GrantActivityPeriodstartdate:* ______Enddate:* ______

DetailedInfoAbouttheWorkforWhichYou'reSeekingFunding

Descriptionoftheissueoropportunityyou'refocusedonandthegrouporcommunitytobeaffectedbywork(1-3 paragraphs, doublespaced.)*

Descriptionofthespecificworkyou’lldo. (1-3 paragraphs, doublespacedplease.)*

BudgetandFundingfortheWork

Totalestimatedcostofproject:*$ ______

Preliminarylistofexpensesthatmakeuptheestimatedcostlisted above.*

Expense(s) Amount

______$ ______

______$ ______

______$ ______

______$ ______

TOTAL$ ______

OverallSourcesofFundingAmount

GrassrootsFundraising/RecurringDonors $ ______

F4DC MatchingGrant $ ______

______$ ______

______$ ______

TOTAL$ ______

Usethespacebelowtoprovidedetailabouthowyouarrivedattheestimatedexpensesaboveandtodescribefundingsourcesoutsideofgrassrootsfundraising, recurringdonorsandthe F4DC matchingfunds.

*FundraisingPlan: Inthespacebelow, describeyourplanstoraiseeither:

• grassrootsfunds(donationsof $100 orless)
• newrecurringdonors

TaxStatusofYourOrganization

Doesyourorganizationhave 501(c)(3) nonprofittaxstatus?* Yes ____ No____

Ifyes:

Dateyourorganizationwasgrantedtaxexemptstatusbythe IRS:* ______.

Yourorganization's EIN number: ______.

Pleaseattach a copyofyourorganization's IRS taxexemptionletter.

Ifno,designate a qualifiedtaxexemptorganizationtoactasyourfiscalsponsor.

Nameoforganizationactingasyourfiscalsponsor:*

______

FiscalsponsorContactPerson:* ______

FiscalsponsorAddress:* ______

FiscalsponsorPhone:*______

FiscalsponsorEmail:* ______

Pleaseattach a letterfromyourfiscalsponsor, onletterhead, inwhichtheystate:

• Willingnesstoserveasfiscalsponsorforyourgrouporprojectforpurposesofthisgrant
• Thedateonwhichtheirgroupreceivedtaxexemptstatus
• Theirorganization's EIN number

Eitheryouorthefiscalsponsormustattach a copyofthefiscalsponsor's IRS taxexemptionletter.

Fund for Democratic Communities(336) 497-1854

620 S. Elm St., Suite

Greensboro, North Carolina 27406