Committed to Florence
   Committed to Pinal County
Florence Copper Community Foundation

Application Form

Most fields are required. For any section that does not apply to your organization, please mark "N/A."

Grant Application

Organization Name:


Project Name (if any):


Organizational Information:
1. Organization's History:

2. Organizational Goals and Objectives (short-term and/or long-term):

3. Programs and Services (briefly describe your organization's programs and services):

4. Organizational Structure (board, staff, volunteers):

Proposal Information:
5. Description of Program/Project:


6. Description of Need (What is the issue you plan to address? What is your approach?):


7. Specific Activities (Include information about service delivery and/or timeline.):


8. Objectives and Goals for this Request (How will this grant strengthen the organization, address the issues, make improvements, or achieve success?):

9. Evaluation (What are the anticipated outcomes and how will you know if you are successful?):


10. Other (Use this space to provide any additional information that you feel would be relevant to this grant request that is not covered in the sections above.):

Budget Information:
Provide an explanation/justification of funding request and the amount

Grant Application Cover Sheet

Date of Application:

Organization Information


Name of organization

Legal name, if different

Address

City, State, Zip

Employer Identification Number (EIN)

Phone

Fax

Website

Name of top paid staff

Title

Phone

Email

Name of contact person regarding this application

Title

Phone

Email
Is your organization an IRS 501(c)(3) not-for-profit? Yes No
If no, is your organization a public agency/unit of government? Yes No


Fiscal agent's EIN number


Proposal Information

Please give a 2-3 sentence summary of request:
Population Served: Geographic area served:

Interest area of grant (check one)
Education Environment
Cultural Heritage, Art & Tourism Health & Wellness
Community & Economic Development  

Funds are being requested for (check one)
General operating support Start-up costs Capital
Project/program support Technical assistance Other (list)



Project dates (if applicable): Fiscal year end:


Budget

Total annual organization budget: $
Total project budget (for support other than general operating): $


Authorization

Name and title of top paid staff or board chair:

 
Florence Copper Community Foundation