Westbrook Foundation



THE WESTBROOK FOUNDATIONGRANT APPLICATIONDue April 1 or October 1Applicant InformationName of Organization: Date:Mailing Address: Application Contact Person: Title of Contact Person:Telephone:Email:Organization Website:Partnering Organization or Fiscal Agent Information (if applicable)Name of Partnering Organization or Fiscal Agent: Mailing Address:Partnering Organization or Fiscal Agent Contact Person: Title of Contact Person:Telephone:Email:Project InformationProject Summary (10- to 15-word description)This grant will support:Total Project Budget:Grant Request: $Project Start and End Dates (mm/dd/yy – mm/dd/yy)Application NarrativeIn a narrative of no longer than four typed pages, address each of the bullet points under the following three review criteria. Organize the narrative using the review criteria as headings: Quality of the project; Impact of the project; and Evaluation and ability to carry out the project. Note that the project budget is part of the four-page narrative.Review Criteria # 1Quality of the projectProvide a detailed description of the project—its purpose, design, and activities.Define the geographic area and target demographic (including estimated number of people) that the project will serve. Provide a timeline of the project—from planning to implementation.Describe the personnel (and their qualifications), including external professionals, who will work on the project. Describe the level of community support for this or similar projects, if applicable.?Review Criteria # 2Impact of the projectDescribe the need for the project—its uniqueness and non-duplication.How does the project address the interests and needs of Westbrook residents? What are the expected outcomes or anticipated benefits of the project?To what extent will the project enhance the goals and objectives of your organization (and partners, if a collaborative effort).?Review Criteria # 3Evaluation and ability to carry out the projectOutline the roles and responsibilities of board members and staff involved in carrying out the project (including board members and staff of the partnering organization, if a collaborative effort).Provide a detailed project budget, outlining project expenses and other sources of funding (how much, from whom, and for what), if applicable.?Explain how requested funds from the Foundation will be used.Describe the evaluation plan. What methods will be used to measure expected outcomes and project success? What are the organization’s plans for sustaining this project beyond the life of the grant?THE WESTBROOK FOUNDATIONGRANT APPLICATIONFULL APPLICATION CHECKLIST Application Form: To be dated and signed (one original and three additional copies)Application Narrative: To be no longer than four pages, and to include the project budget (four copies)Required Attachments (one copy of the following):IRS Tax-Exempt Determination Letter from applicant and each partnering organization Most recent Form 990 from applicant and each partnering organization Mission statement of applicant and each partnering organizationCurrent operating budget showing anticipated revenues by source and expendituresFinancial statements and/or audited report. If the audited statement is unavailable, a treasurer’s report is acceptable. A list of the applicant’s current board of directors and, if a collaborative effort, each partneringorganization’s board of directors.Signature of Applicant Authorized Official: __________________________________________Printed Name: _________________________________________________________________Title: ________________________________________ Date: ___________________________Application DeadlineSubmitted by or postmarked no later than April 1 or October 1Send full application with all required attachments to:GRANT APPLICATIONTHE WESTBROOK FOUNDATIONP. O. BOX 528, WESTBROOK, CT 06498Please direct questions to An-Ming Truxes, grants committee chair, via email at grants@ ................
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