Application_.pdf



Eligibility: Are you an IRS-recognized 501(c)(3) tax-exempt organization operating in Charles County? Has your organization been in operation continuously since March 1, 2019?Is your organization in good standing with the State of Maryland? Application:Legal Name of OrganizationAddressEmailPhoneWebsite EIN #Application ContactNameEmail PhoneYear Organization Was EstablishedIRS Letter of Determination Upload your document here Organizational Summary (300 words or less)What is the mission of your organization, what populations do you serve and where are they located in Charles County. How many individuals do you estimate your organization will serve this year?What is total amount of this fiscal year’s general operating budget?Amount of Grant Request $________ Documentation of Revenue Loss of at least 20% beginning March 1, 2020 and ending August 31,2020. For local chapters/offices of regional or national organizations, submit local budgets for Charles County operations only. Skip this section if you are not applying for funds to cover revenue loss.Briefly describe your revenue losses related to the Covid-19 pandemic from March 1- August 31, 2020 (200 words)Upload your FY20 Monthly Profit and Loss statement showing a reduction in revenues from March 1, 2020 – August 31, 2020. OR other verifiable method to prove the lossUpload your FY19 Monthly Profit and Loss statement from March 1, 2019 – August 31, 2019 for comparison purposes What percent is your revenue loss?Documentation of Revenue Loss between September 1, 2020 – December 30, 2020.If you anticipate additional revenue loss (for example cancellation of annual fundraising event, loss from space rental, proof of other revenue declines) between September 1, 2020 – December 30, 2020, please indicate the amount of the projected losses, the reason for them and the percent of revenue loss for this period.(300 words or less)Documentation of Request for Covid-Related Direct Expenses Revenue loss is not required.Briefly describe your request for funds to cover expenses for Covid-19-related goods and services incurred between March 1-December 30, 2020 that were not covered by other grants or sources of income. (300 words)Program/Project BudgetDownload the budget template, fill it out and upload Budget Narrative (300 words or less) Optionally, use this space to explain any aspects of your grant request that are not evident in your budget submissions and descriptions above.FY19 Full Year Profit and Loss Statement Upload your budget hereUpload Most Recent 990 or 990-EZ if you are required to ?le one by the IRS If you are not required to submit either of these documents, submit your most recent financial audit report or Profit and Loss Statement signed by an authorized person in your organization. By submitting this application, the authorizing contact assures that the information submitted in this application is accurate.Authorizing Contact:Executive Director or Managing Head of OrganizationNameEmail Phone ................
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