Application_.pdf
Eligibility: Are you an IRS-recognized tax-exempt organization operating in Charles County with an IRS determination letter dated no later than May 31, 2020? Has your organization been in operation continuously since May 31, 2020?Is your organization in good standing with the State of Maryland? Does your organization have a physical location/address in Charles County?Application:Legal Name of OrganizationCharles County AddressEmailPhoneWebsite EIN Application ContactNameEmail PhoneYear Organization Was IncorporatedStart Date of Current Fiscal YearIRS 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 fiscal year? What is the total amount of this fiscal year’s general operating budget? Did your organization receive a grant award(s) in 2020 from the Nonprofit Recovery Initiative Program (NORI) administered by the Maryland Department of Housing & Community Development?Yes ___ No ____ If Yes, what is the total amount of the grant award(s) you received in 2020? $____________ Did your organization receive a grant award(s) in 2020 from the CARES Act Emergency Relief program administered by the Charles County Charitable Trust? Yes ___ No _____ If yes, what is the total amount of the grant award(s) you received in 2020? $____________GRANT REQUEST:You may request funding for any or all categories of funding. For an explanation of each category of funding, go to uses of awarded funds may include revenue loss for the period March 1, 2020 through December 31, 2021, and for goods and services during the same period of time as long as those expenses have not already been supported by COVID relief or other funding. Funds must be expended no later than December 31, 2021. For local chapters/offices of regional or national organizations, submit local financials for Charles County operations only. Amount of Grant Request $________ Category A: Net Revenue Loss during the period March 1, 2020 to May 31, 2021.(Skip this section if you are not applying for funds to cover net revenue loss between March1, 2020 to May 31, 2021.) What is the amount of your net revenue loss between March 1, 2020 and May2021.$__________________Briefly describe the reasons for your net revenue losses: (200 word limit) Upload up to 3 financial documents that provide evidence of net revenue loss. For example, budget vs. actuals for the period of loss compared to budget vs. actuals for the same period of loss in the previous year. Because of the pandemic in 2020, you may also need to provide 2019 financials to provide evidence of loss.Category B: Projected Net Revenue Loss between June 1, 2021 – December 31, 2021.(Skip this section if you are not applying for funds to cover projected net revenue loss between June 1, 2021 and December 31, 2021. What is the amount of your projected net revenue loss between June 1, 2021 and December 31, 2021.$________________ Briefly describe the reason(s) for your projected net revenue loss (for example, cancellation of annual fundraising event, loss from space rental or other revenue declines) between June 1, 2021 – December 31, 2021. (300 words or less) Upload up to 3 financial documents that provide evidence of projected net revenue loss. For example, profit and loss statement for the period of projected loss compared to profit and loss statement for the same period of loss in 2020. Because of the pandemic, you may also need to provide 2019 financials to provide evidence of projected loss.Category C: Direct Cost of Goods and Services caused by hardship during the period March 1, 2020 and December 31, 2021. (Skip this section if you are not applying for funds to cover direct cost of goods and services.)Net Revenue loss is not required. Briefly describe your request for funds to cover the cost of goods and services incurred between March 1, 2020-December 31, 2021 that were not or will not be covered by other grants or sources of income. (300 word limit) Program/Project BudgetDownload the budget template, fill it out and upload it.Budget Narrative (300 words or less) Optionally, use this space to explain any aspects of your financials that support your grant request. If you are applying in more than one category, identify each of the categories of funding for which your comments apply.ADDITIONAL FINANCIAL DOCUMENTS REQUIRED:FY20 Profit and Loss Statement Upload your document hereUpload Most Recent 990 or 990-EZ if you are required to ?le one by the IRS, and/or most recent independent audit or review in compliance with state and/or federal regulations or by choice.If you are not required to submit either of these documents, submit your most recent financialaudit report or FY20 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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