ROUNDY’S FOUNDATION
GRANT APPLICATION
For decades, Roundy’s has contributed to the well being of the communities we serve through our corporate giving program. The Roundy’s Foundation was created to further strengthen our commitment to the communities in which we have a presence by donating funds and food to organizations such as food banks, women’s and family violence shelters.
FOUNDATION OVERVIEW
The Roundy’s Foundation is one of the newest corporate foundations created in the Milwaukee area. Chartered in August 2003, the Foundation’s goals are to enhance the quality of life for those most in need in the communities in which we live and do business by focusing its efforts on:
§ Hunger relief
§ Domestic Abuse/Violence
Hunger Relief
We support healthier communities with hunger relief initiatives, and by supplying products and financial donations to organizations and non-profit food distribution centers. The Foundation also provides funding and assistance to food banks and seeks to be involved in self-help programs that give people a long-term solution to hunger.
Domestic Abuse/Violence
We fund programs that work to create stronger communities with stronger families by providing assistance and training, focusing on prevention and intervention efforts. Grants from the Foundation support programs dedicated to assisting families and individuals in conflict, under duress or in need due to Domestic Abuse/Violence.
HOW TO APPLY
If your organization qualifies as a charitable, not-for-profit 501(c)(3) tax exempt organization under the Internal Revenue Service Code guidelines, is located in a community served by Roundy’s, Supermarkets, Inc., and falls under one of the two areas of focus, you are eligible to apply for a grant.
Please follow these instructions for completing the application:
§ Type and single-space all proposals (minimum 10 point).
§ Provide all of the information in the order listed.
§ All questions relative to the request must be completed fully.
§ Submit only one copy with numbered pages; do not bind or staple.
§ Do not include materials other than those specifically requested at this time.
§ Do not send videotapes.
Submit the following attachments with the completed proposal:
1. Complete list of the organization's officers and directors
2. The organization's actual income and expense statement for the past fiscal year, identifying the organization's principal sources of support
3. The organization's projected income and expense budget for the current fiscal year, identifying the projected revenue sources
4. The organization's most recent audited financial statement including notes and IRS Form 990
5. Copies of the IRS federal tax exemption determination letters
Mail to:
Roundy’s Foundation
MS-2175
P.O. Box 473
Milwaukee, WI 53201-0473
The Roundy’s Foundation Grant Application Page 1 of 7
October 2003, Updated 2012
Roundy’s Foundation Grant Application
Provide the following grant information in this order. For your convenience, you may choose either to copy and fill out this cover summary, or create your own using the headings listed below.
Date Submitted:
Total Proposed Project/Program Budget: Amount Requested:
Program Name:
Duration of Project/Program: from to When are funds needed?
Nature of Request: Project Program
Organization Information:Name and address:
Phone number: FAX Number: Email of contact person:
FEI #: Date of Incorporation:
Organization must posess and attach copy of 501(c)(3) letter from IRS
Chief Staff Officer/Title: Phone number:
Contact Person/Title: Phone number:
Board Chairperson/Title: Dates of organization's fiscal year:
Organization's total operating budget for past year and current year
Has the governing board approved a policy which states that the organization does not discriminate as to age, race, religion, sex or national origin? Yes No If yes, when?
Has the organization’s chief executive officer authorized this request? Yes No
An officer of the organization’s governing body must sign this application:
The undersigned, an authorized officer of the organization, does hereby certify that the information set forth in this grant application is true and correct, that the Federal tax exemption determination letter attached hereto has not been revoked and the present operation of the organization and its current sources of support are not inconsistent with the organization’s continuing tax exempt classification as set forth in such determination letter.
______
Signature Print Name/Title Date
Enclose all required support materials with the application (See page 2, How to Apply).
NARRATIVE
PLEASE PROVIDE THE FOLLOWING INFORMATION IN THE ORDER PRESENTED BELOW. NOTE SECTIONS THAT ARE NOT REQUIRED FOR GENERAL OPERATING SUPPORT. REFER TO THE GLOSSARY OF TERMS AS NEEDED WHEN PREPARING THE NARRATIVE.
(No more than five pages; ten point minimum; one inch borders; include applicant’s name on the top of each page)
Project/Program Abstract (not required for general operating requests)
Describe in three to five sentences the proposed program, how it relates to the organization’s mission, capacity to carry out the program and who will benefit from the program.
Organization Information
Provide a brief summary of the organization’s:
- mission, goals, programs, and major accomplishments, success stories and qualifications;
- show evidence of client & community support
- description of the population served, including total number, geographic, demographic,
- and socio/economic characteristics
- total number of paid staff and volunteers (differentiate between board members, program and office volunteers)
Project/Program Description (not required for general operating requests)
§ Explain the significance/scope of the program and why your organization is qualified to carry it out.
§ Describe the expected outcomes and the indicators of those outcomes.
§ Describe the evaluation process and how the results will be used.
§ Document the size and characteristics of the population to be served.
§ Outline the strategy/methodology and timeline to be used in the development and implementation of the program.
§ What linkages/collaborations will be used?
§ How do you plan to involve the population you intend to serve in the design?
§ How does this program enhance the existing services in the community?
Funding Considerations
Describe plans for obtaining other funding needed to carry out the project/program or organizational goals, including amounts requested of other funders. If the project/program is expected to continue beyond the grant period, describe plans for ensuring continued funding after the grant period. List the top five funders of this project (if applying for a program grant) or organization (if applying for general operating support) in the previous fiscal year, the current year, and those pending for the next fiscal year.
The Roundy’s Foundation Grant Application Page 1 of 7
October 2003, Updated 2012
Roundy’s Foundation Grant Application
Send a capital budget if you are requesting capital support.PROJECT/PROGRAM BUDGET
Organization Name:
PROJECT/PROGRAM REVENUE
/ Total Revenue / Committed / Pending /1. United Way Allocation / $ / $ / $
2. Other Federated Campaign Allocations
3. Contracts (list specific sources on following page)
4. Grants (list sources on following page: Foundations, Corporations & Government)
5. In-Kind Support (list specific sources on following page)
6. Client and Program Service Fees and Other Earned Revenue
7. Contributions (Gifts from Individuals)
8. Other Revenue (list specific sources on following page including any endowment income)
TOTAL PROJECT/PROGRAM REVENUE / $ / $ / $
PROJECT/PROGRAM EXPENSES
1. Salaries (provide detail by position on a separate page, except for United Way applications) / $2. Benefits/Taxes
3. Professional Fees (itemize on following page)
4. Supplies, Printing, Duplicating
5. Travel
6. Telephone
7. Occupancy
8. Payments to Affiliates
9. Program/Project specific major property & equipment Acquisition
10. Inkind Expenses (itemize on following page)
11. Other Expenses (itemize on following page)
TOTAL PROJECT/PROGRAM EXPENSES / $
(Please note: revenue and expenses should add up to total project revenue and expenses.)
PROJECT/PROGRAM REVENUE SUPPLEMENT
(Please indicate revenue sources as committed or pending)
Use additional sheet if necessary
Contracts (list) Total Revenue Committed Pending
Grants (list)
In-Kind Support (list)
Other (list)
PROJECT/PROGRAM EXPENSES SUPPLEMENT
Use additional sheet if necessary
Salaries (Detail by position) In-Kind Expenses (list)
Professional Fees (list) Other Expenses (list)
The Roundy’s Foundation Grant Application Page 1 of 7
October 2003, Updated 2012
Glossary of Terms
Capital Request – A planned undertaking to purchase, build or renovate space or building or to acquire equipment.
Community – The people living in the same district, city, state, etc.
Contribution – A tax-deductible gift, cash, property, equipment or services from an individual to a non-profit organization. Most often given annually.
General Operating Support – Funds, both contributions and grants, which support the ongoing services of the organization.
Grants – Generally an allocation from foundations, corporations, or government for special projects or general operating. May be multi-year or annual.
Indicator – The observable, measurable characteristic or change that represents achievement of the outcome.
In-Kind Support – A contribution of equipment/materials, time, and or services that the donor has placed a
monetary value on for tax purposes.
Methodology – A sequence of activities needed to accomplish the program objectives.
Outcomes – The changes in (or benefits achieved by) clients due to their participation in program activities. This may include changes to participants’ knowledge, skills, values, behavior, or condition of status.
Performance Standard – The number and percent of clients who are expected to achieve the result. Also called target, they should be based on professional judgment, past data, research, or professional standards.
Program – An organized set of services designed to achieve specific outcomes for a specified population that will continue beyond the grant period.
Project – A planned undertaking or organized set of services designed to achieve specific outcomes that begins and ends within the grant period. (A successful project may become an ongoing program.)
Success Story – An example that illustrates your program’s effect on a client.
The Roundy’s Foundation Grant Application Page 1 of 7
October 2003, Updated 2012