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-336552540For Office Use Only00For Office Use Only NATIONAL LEVEL APPLICATION-7302543815Office useProject Number00Office useProject NumberSend a copy via email to clara.nunez@ and follow up with an email or phone call to assure that your email arrived. All notifications are done via email. Please call or email any question or request.Letters of Recommendation: Three letters of recommendation from established community leaders and/or established organizations to demonstrate the group’s work experience are required with each application (i.e. local government persons, persons at Community Foundations, Pastors, Bank representatives, local church, United Way, Salvation Army, a well-established community organization, etc.). The letters must be on letterhead. PROJECT INFORMATIONName of the Project: FORMTEXT ?????Organization: FORMTEXT ?????Physical Mailing Address (No P.O.BOX): FORMTEXT ?????City, State and Zip Code: FORMTEXT ?????Website/social media (if applicable): FORMTEXT ?????350012019050SECONDARY CONTACT PERSON 00SECONDARY CONTACT PERSON 18288026406PRIMARY CONTACT PERSON 00PRIMARY CONTACT PERSON Full Name: FORMTEXT ?????Full Name: FORMTEXT ?????Title: FORMTEXT ?????Title: FORMTEXT ?????Cell: FORMTEXT ?????Cell: FORMTEXT ?????Work Phone: FORMTEXT ?????Work Phone: FORMTEXT ?????Home Phone: FORMTEXT ?????Home Phone: FORMTEXT ?????Email: FORMTEXT ?????Email: FORMTEXT ?????Name of the person who completed this application, if different from above: FORMTEXT ????? *Keep your contact information updatedSTATUS/HISTORY OF YOUR ORGANIZATION: (No more than 300 words for each answer. You can use bullet points)When was the group/organization founded, by whom and for what purpose (include the mission statement if available)? FORMTEXT ?????How many members are in the group? FORMTEXT ???? (SDOP seeks to partner with communities; it is unusual for a community group of less than 10 people to receive funding.)Who owns and controls the group/organization? FORMTEXT ?????Is the majority of the group below poverty level? YES FORMCHECKBOX NO FORMCHECKBOX How does the group define poverty? FORMTEXT ?????Who makes decisions and how are they made? FORMTEXT ?????How will the group members benefit directly from this project? FORMTEXT ?????Does the group’s mission include some or all of the SDOP core strategies (promote justice, build solidarity, advance human dignity and advocate for economic equity? YES FORMCHECKBOX NO FORMCHECKBOX If yes, select all that apply: FORMCHECKBOX Promote Justice FORMCHECKBOX Build Stronger Communities FORMCHECKBOX Seek Economic EquityTHE PROPOSAL (Review SDOP’s Criteria Before Completing This Application)The amount you are requesting $ FORMTEXT ????? (Grants usually do not exceed $15,000)Describe the project and why it is needed. FORMTEXT ????? What are the 1-2 main project goal(s)? (What will be different because of what the group is trying to do?) FORMTEXT ?????How do you propose to achieve the goals (include specific timelines of activities)? FORMTEXT ??????????How will you measure success? FORMTEXT ????? DECISION MAKERSAre any of the decision makers related? If so, who are they and how are they related? FORMTEXT ?????b. LIST THE DECISION MAKERS (majority must be below poverty level REQUIRED) (use additional page if needed)NAMEETHNICBACKGROUNDJOB/OCCUPATION(if applicable)POVERTY LEVELAbove (A) or Below (B)INDICATE HOW CHOSENElected (E), Appointed (A) or Self-Selected (S) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ???REQUIRED BUDGET (use additional page if needed) This budget covers the following dates: Click or tap to enter a date. to Click or tap to enter a date.EXPENSES - Total expenses must equal total income Itemize expenses over $1,000 (Example: number of bags of soil, number of events)ItemPurpose/RationaleSDOPOther SourcesExample: Office rentExample: Provide group work and meeting space$500$300 FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ??????? FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ?????TOTAL$ FORMTEXT ?????$ FORMTEXT ?????INCOME SourceAmountReceived? Committed?SDOP$ FORMTEXT ?????YES FORMCHECKBOX NO FORMCHECKBOX YES FORMCHECKBOX NO FORMCHECKBOX Individual Cash Donations$ FORMTEXT ?????????YES FORMCHECKBOX NO FORMCHECKBOX YES FORMCHECKBOX NO FORMCHECKBOX In-Kind (such as goods or services provided at no charge)$ FORMTEXT ????????YES FORMCHECKBOX NO FORMCHECKBOX YES FORMCHECKBOX NO FORMCHECKBOX Fund Raising Events$ FORMTEXT ????????YES FORMCHECKBOX NO FORMCHECKBOX YES FORMCHECKBOX NO FORMCHECKBOX Other FORMTEXT ?????$ FORMTEXT ?????????YES FORMCHECKBOX NO FORMCHECKBOX YES FORMCHECKBOX NO FORMCHECKBOX TOTAL$ FORMTEXT ?????YES FORMCHECKBOX NO FORMCHECKBOX YES FORMCHECKBOX NO FORMCHECKBOX ADDITIONAL INFORMATION How did the group find out about SDOP? (Please check whichever applies) FORMCHECKBOX Community Workshop (indicate where and when) FORMTEXT ????? FORMCHECKBOX Presbyterian Church (USA) event FORMTEXT ????? FORMCHECKBOX SDOP Website or another website (indicate website) FORMTEXT ????? FORMCHECKBOX Local Church (indicate the name and location of the church) FORMTEXT ????? FORMCHECKBOX Word of mouth (provide the name and contact information of the person) FORMTEXT ????? FORMCHECKBOX Other FORMTEXT ?????While SDOP does not require the group to have the items below to award a grant, we would like to know if you have any or all of them. Please do not include copies with your application. By-lawsYES FORMCHECKBOX NO FORMCHECKBOX 501c3 Tax Exempt StatusYES FORMCHECKBOX NO FORMCHECKBOX Articles of incorporationYES FORMCHECKBOX NO FORMCHECKBOX General Liability InsuranceYES FORMCHECKBOX NO FORMCHECKBOX Will the group be using a fiscal agent? YES FORMCHECKBOX NO FORMCHECKBOX If yes, provide the name of the fiscal agent: FORMTEXT ?????(no administrative fees to be paid with the SDOP grant to the fiscal agent)Please check up to three categories that best describe your project:Affordable Housing/Homelessness FORMCHECKBOX Human Rights FORMCHECKBOX Agriculture FORMCHECKBOX Immigration FORMCHECKBOX Arts/crafts FORMCHECKBOX Leadership Development FORMCHECKBOX Capacity Building FORMCHECKBOX Micro-Credit FORMCHECKBOX Community Development FORMCHECKBOX Self-Advocacy FORMCHECKBOX Community Garden FORMCHECKBOX Seniors FORMCHECKBOX Community Organizing FORMCHECKBOX Skills Development FORMCHECKBOX Community Re-entry FORMCHECKBOX Training FORMCHECKBOX Cooperative/Worker Owned FORMCHECKBOX Trafficking FORMCHECKBOX Education FORMCHECKBOX Transportation FORMCHECKBOX Domestic Violence FORMCHECKBOX Water FORMCHECKBOX Economic Development FORMCHECKBOX Women FORMCHECKBOX Environment FORMCHECKBOX Youth FORMCHECKBOX Fair Wages FORMCHECKBOX Other (please add your category if not listed): FORMTEXT ????? Food Security FORMCHECKBOX Health FORMCHECKBOX Please list, and provide contact information, for other grassroots organizations and/or organizations working with these organizations that could help SDOP in our outreach efforts. (These organizations do not need to meet SDOP criteria of being controlled by the direct beneficiaries).? Please include organization’s name, contact person, phone, address, city, state, email. Use additional pages if needed. FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????COMMENTS/FEEDBACK: We value your feedback and invite you to share any suggestions for how to improve the application process. ` FORMTEXT ????? ................
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