Port Gamble S’Klallam Tribe Appendix X
Port Gamble S’Klallam Tribe
Community Awards Program
Application Form
Attach only a copy of your IRS 501(c)(3) letter ruling non-profit status, proof of your non-profit status and federal ID number.
Date: _________________________
Nature of Request:
_____ Capital _____ Operating ____ Project ____Other _________________________
Is the Applicant a:
_____ Tribe _____ Partnership _____ Corporation _____ Sole proprietorship
_____ Other ____________________________________
Does the applicant qualify as a :
_____ Non-profit _____ Charitable Organization _____ IRS 501(c)(3), if so, provide copy of IRS letter ruling.
Name of Applicant: _________________________________________________________________
Contact Person: ____________________________________________________________________
Address: _______________________________________City, State, Zip: ______________________
Telephone Number: _____________________________ Email address:________________________
Program Name: ____________________________________________________________________
Project Start Date:_________________________________ End Date _________________________
Expected Number of Participants: _____Youth _____Elders _____ Adults ______Volunteers _____Others
Amount Requested[1] _________________ Do you expect funding from other sources? (If so, list them)
List consortium partners or programs, if any:
Provide a budget breakdown
Total Proposed Project/Program budget _________________________________________________
EIN Or Social Security Number; ______________________________________________________
Give a brief summary (no more than 100 words) of your program and why you are asking for a grant.
What is your organization’s mission?
Submission of Application
Be certain your application is complete, incomplete applications will not be considered.
Attach only a copy of your IRS 501 (c)(3) letter ruling or proof of your non-profit status and federal ID number. Deadlines are March 31st and September 30th or postmarked by March 31st or September 30th.
Submit completed applications on or before the deadline to:
Natashe Reynolds –
Port Gamble S’Klallam Tribe
31912 Little Boston Road NE
Kingston, WA. 98346
Phone: 360/297-6229
Fax: 360/297-7097
If you have any questions concerning this application or its status, please email to tashejoy@pgst.nsn.us
The Port Gamble S’Klallam Tribal Council requests a brief report when your project is completed.
PLEASE NOTE: Unfunded Applications are not retained.
Community Awards Program
Appendix X
Appendix X (section 14) of the Gaming Compact between the Port Gamble S’Klallam Tribe and the State of Washington, describe specific funds, which are available for award to charitable, non-profit and tribal community programs on a biannual basis. The attached application has been adopted by the Tribe to facilitate the review and award of these funds.
To qualify for a “community award” your group or organization must fall into one of three classifications:
1. 501(c)3 private not for profit organization,
2. Charitable group/organization, or,
3. A Tribal government program, which has an impact on the community. Must have Department Director Approval – signature required on application.
Requests for an award can be made in any amount up to $2,500
Please note that all applications from 501(c)3 organizations must submit a copy of their 501(c)3 certification. Failure to submit the certification will result in your application not being reviewed for an award. A current financial statement is required for all applications. Incomplete applications will not be reviewed. All charitable groups must furnish proof of their non-profit status.
The Port Gamble S’Klallam Tribal Council has further prioritized the granting of awards to those applicants with projects that accomplish one or more of the following categories:
• Youth education activities
• Youth prevention/recreation
• Activities for senior citizens
• Food and nutrition programs
• Wellness and mental/physical health
• Family oriented community events
• Family strengthening projects
• Environmental preservation and restoration
• Community planning processes
• Art/cultural projects or events
• Local historical projects
• Veterans assistance/support
Project applicants are not limited to these categories and are encouraged to submit regardless of a projects focus. Application deadlines are biannually and are due March 31st and September 30th each year. Projects will be awarded within 60 days of the application deadline.
The Tribe requests that a performance report covering the use of funds be submitted to the Tribe within one (1) year of award date.
If you have any questions, you may contact the Port Gamble S’Klallam Tribe at 360/297-6229. You may download an application at pgst.nsn.us or request to have one faxed to you.
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[1] Request exceeding $2,500 are discouraged and will be subject to special review.
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