Online Grant Application





Name of Organization: *

Address 1: *

Address 2:

City: *

State: *

Zip Code: *

Website:

Contact Person: *

Title: *

Phone 1: *

Phone 2:

E-mail Address: *

 

Briefly describe the history, mission and general information about your organization (100 words or less). *

 

PURPOSE OF REQUEST

What is your request? *

Amount requested: *

Is this part of a multi-year request? *
 Yes No

If so, please explain:

If the program is on-going, how will it be sustained?

 

Briefly discuss your program (300 words or less). *
If more than one request, use separate application form for each request. You may upload two-to-three attached pages of photos, layouts, descriptions to help clarify your request. No more than three pages will be accepted. Please include the following in your discussion: what needs will the program address? Who will the program serve? How many people will benefit from this program? Why do you feel this program is important to the community?

Upload supporting documents here (use zipped folder for multiple files):

 

How does your program meet the mission of The Blazer Foundation? *

How will you measure the program’s success? *

 

FINANCIAL DISCUSSION OF THE PROGRAM

Provide a brief financial overview of your organization. Include funding sources and a recent balance sheet. *

Upload balance sheet here:

 

Provide an income and expense budget for this program. *

Upload budget document here:

 

Include current funding sources for this project. *

Staff/administrative costs (dollars and as percentage of budget): *

Have you requested funds from any other sources for the same purpose? *  Yes No

If you have requested funds from any other sources, please list all to whom you have applied.

When are the funds needed? *

 

ADDITIONAL INFORMATION

Please provide a list of your agency’s board of directors. *

Please attach a copy of your 501(C)(3) tax exempt letter from the IRS.

 

If a site visit or presentation to The Blazer Foundation Board of Directors is required, who is the contact to arrange these?

Name:

Phone:

E-mail Address:

 

SIGN & SUBMIT

Applicant’s Full Name / Title: *

Date: *

 

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INSTRUCTIONS:

1. All fields marked with a red asterisk * are required.

2. Online progress cannot be saved. Please review the entire form to ensure you have required documentation on hand before you begin.

3. Uploading Supporting Documentation/Images:

  • Several requests for external documents are highlighted throughout this application.
  • To upload a document: click Browse > select the document from your computer > click Open. Once the file name appears next to the Browse button, proceed with the application.
  • Multiple files must be compressed (zipped) into one folder before you can upload them (e.g. example-folder-name.zip).
  • File size limit (per upload): 3MB.
  • For large image files, we recommend first reducing the file size using photo editing software or a free online program such as http://www.pixlr.com.