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The Cemala Foundation

Cemala Foundation Online Grant Application

 

Instructions

  • We use Adobe Acrobat forms that require the free Adobe Acrobat Reader version 5.0 or higher. Get the newest reader here. (new window)
  • To complete an online grant application, you must be a registered user and have read the Cemala Foundation Grant Guidelines. The information you enter below will be saved to your account only for the duration of this grant cycle.
  • You can edit or add information to this form by returning to this page, logging in, and editing the application. (Bookmark this page)
  • You can print the application using the print button at the bottom of this page.
  • You cannot email this application from the Web site. The form must be printed, signed, and submitted with any supporting material by postal mail or other delivery.

 

Grant Guidelines

I have read the grant guidelines.

 

General Information

Name of organization

 

MAILING ADDRESS

Street

City

State         Zipcode

Telephone

Fax

CONTACT PERSON FOR APPLICATION

Contact's phone

Contact's fax

Title

Email

Date of 501(c)(3) determination

Web site address (if available)

 

Grant Request

INDICATE TYPE OF GRANT REQUEST

New program   Expansion of existing program    Capital improvements
General operating support   Operating support for emergency   Other

Title of project (not required for general operating support)

Amount of request to Cemala

Total project cost (not required for general operating support)

Summary description: Explain how the grant funds will be used, what will be accomplished, who will benefit and what will change in the community if this request is funded.

Describe collaborative efforts - formal or informal - you have established or plan to establish with organizations working on similar issues or providing similar services (how do you coordinate with or complement one another)?

 

Primary Funding Sources

List primary funding sources with amounts for this project

Committed

Name Amount

Name Amount

Name Amount

Name Amount

Pending (give determination date)

Name Amount

Name Amount

Name Amount

Name Amount

 

 

Future funding plans: If this request is for project funding, and if project is to be continued, how will it be funded in the future? If this request is for operating support, how will operating support be funded in the future?

Brief description of your organization's history, mission and primary activities. If this grant request is for a start-up, explain the need for these new servcies and whether or not they are provided elsewhere in the community.

 

Financial Resources

Organization's net assets as of last fiscal year end (date)

Revenues and expenditures for the last fiscal year end

Income      Expenditures

Current fiscal year budget

Income      Expenditures

Sources of funding

%Membership %United Way %Annual campaign, events
%Fees %Goverment %Other

 

Human Resources

Number of members of governing board:

Number of paid staff :    full time      part-time


We are not finished and wish to edit the form further at a later date. I understand that my data will be deleted at the end of the current grant cycle. (Bookmark this page)


We are finished and wish to print the form on our own printer. We will sign the form and deliver it to The Cemala Foundation by postal mail or other means. We understand that this form cannot be emailed to The Cemala Foundation from this Web site.