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Marian and Wayne Sinsel Fund

of The Columbus Foundation

The purpose of The Marian and Wayne Sinsel Fund of The Columbus Foundation is to provide support to minor individuals or full-time students through age 22, residing in Hocking County, Ohio, with any type of hearing impairment. The fund welcomes requests from organizations having recognition under Section 501(c)(3) of the Internal Revenue Code. The fund makes no grants directly to individuals. Project requests may include any goods or services that assist a hearing-impaired child overcome his or her impairment. Examples include, but are not limited to equipment, medical services, technology, and education. No benefits are to be provided to any individuals that would relieve any school district or government agency on any level from providing legally mandated goods or services to the individual.

The following elements are required for application:

Proposal Elements

• Proposal coversheet

• Project narrative (see requirements below)

• Most recent audited financial statement or 990 tax return

• List of the members of the governing board or policymaking body

• Operating budget for the current year (form attached)

• Project budget (form attached)

• Budget narrative explaining line items in project and operating budget

• Copy of Internal Revenue Service 501(c)(3) letter

• Letters of recommendation (no more than two)

Project Narrative

To complete this application, please compile the following information. Limit your narrative to two or fewer pages and no less than 12-point type. Handwritten applications will not be accepted.

• Provide a brief history of the organization (mission statement, description of the programs offered, population served, how the organization is funded, names and qualifications of key staff members).

• Describe the level of need in the community for the project selected.

• Describe the project for which you are seeking funding. Include your goals and objectives as well as a plan for achieving them. How specifically will this project assist hearing-impaired youth in Hocking County?

• Provide your plan for evaluating the project. (Grantees will be asked to submit a final report one month after funding ends.)

• Explain your plan for raising money to continue the project once the grant from the Marian and Wayne Sinsel Fund ends.

Applications and questions are to be submitted to Barbara Fant at The Columbus Foundation at 614/251-4000 or bfant@.

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Marian and Wayne Sinsel Fund

of The Columbus Foundation

|General Information |

|Organization Name:       |

| |

|Address: |Executive Director: |

|      |      |

|      |Project Director: |

|      |      |

|Project Address (if different from above) |Project Director Phone Number: |

|      |      |

|      |Project Director E-mail: |

|      |      |

|Project Information |

|Amount Requested: |Time Period of Project: | |

|      |From:       |To:       |

|Brief Description of Project (limited to space provided): |

|      |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

|I certify that the above information is true to the best of my knowledge and that no benefits will be provided to any individuals that would relieve any |

|school district or government agency on any level from providing legally mandated goods or services to the individual. |

| | |      |

|Signature of Executive Director | |Print Name |

|      | |      |

|Title | |Date |

|The organization above has the authority to submit this request. |

| | |      |

|Signature of Board Chair | |Print Name |

|      | |      |

|Title | |Date |

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| |

|Total Organization Budget for Current Fiscal Year |

|Organization Name: |

|      |

| |

|Organization Fiscal Year (m/d/yy): |

|      to       |

| |

|REVENUE/SUPPORT | | |

| |Budget for Year |Year-to-Date |

| | |(Specify date [m/d/yy]:       ) |

|Corporate Contributions |      |      |

|Foundation Contributions |      |      |

|Federal, State, Local, Government |      |      |

|Individual Contributions |      |      |

|United Way |      |      |

|Other Federated Campaigns* |      |      |

|Membership Dues |      |      |

|Special Events |      |      |

| Sponsorships |      |      |

|Earned Income |      |      |

|Interest and Dividend Income |      |      |

|In-Kind |      |      |

|Other* |      |      |

|Total Revenue/Support |      |      |

|EXPENSES | | |

|Salaries and Wages |      |      |

| Employee Benefits and Taxes |      |      |

|Contract Services/Professional Fees |      |      |

|Equipment, Supplies, Materials |      |      |

|Postage, Mailing, Printing |      |      |

|Occupancy |      |      |

|Insurance |      |      |

|Training, Staff Development |      |      |

|Travel |      |      |

|Conferences |      |      |

|Evaluations |      |      |

|In-Kind |      |      |

|Other* |      |      |

|Total Expenses |      |      |

|Revenue less Expenses |      |      |

*Please list and explain in budget narrative.

If expenses exceed revenues/support, please explain how difference will be offset.

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| |

|Project Budget |

|Organization Name:       |

|Project Start Date (d/m/yy):       to Project End Date (d/m/yy):       |

|PROJECT REVENUE |

| |Anticipated |Committed |Total |

|Contributed Income | | | |

|Local Government* |      |      |      |

|State Government* |      |      |      |

|Federal Government* |      |      |      |

|The Columbus Foundation |      |      |      |

|United Way of Central Ohio, Inc. |      |      |      |

|Other Foundations* |      |      |      |

|Corporations* |      |      |      |

|Board/Individual Contributions |      |      |      |

|Other* |      |      |      |

|Earned Income | | | |

|Client Fees |      |      |      |

|Membership Dues |      |      |      |

|Contract Services* |      |      |      |

|Publications and Products |      |      |      |

|Ticket Sales |      |      |      |

|Organization Income |      |      |      |

|Other* |      |      |      |

|Total Project Revenue |      |      |      |

|PROJECT EXPENSES |

| |Foundation Request |Other |Total |

| | |Funding | |

|Personnel Expenses | | | |

|Salaries and Wages* |      |      |      |

|Employee Benefits and Taxes |      |      |      |

|Non-Personnel Expenses | | | |

|Contract Services/Professional Fees* |      |      |      |

|Office Space |      |      |      |

|Equipment/Supplies |      |      |      |

|Staff/Board Development |      |      |      |

|Travel/Related Expenses |      |      |      |

|Indirect Costs* |      |      |      |

|Other* |      |      |      |

|Total Project Expenses |      |      |      |

|Excess* (Deficiency)* | | |      |

* Please list and explain in budget narrative.

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