| Name of Applying Organization: |
| Organization's Name |
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| Organization Address and Website |
| Organization's Mailing Address |
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| Organization's Town or City |
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| Organization's State and Zip Code |
State:
Zip Code:
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| Organization's Website (if applicable) |
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| Organization's Annual Budget |
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| Contact Information for Representative Completing this Application |
| Representative's Full Name |
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| Representative's Email Address |
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| Daytime Phone Number |
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| How did you hear about us: |
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| If Other Please Specify |
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| Amount Requested: Please be aware that most grants will be between $250 and $2,500. |
| Amount Requested $ |
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| "If your organization does not have a bank account and cannot deposit a potential grant check from the Community Catalyst Fund, you will need to designate a fiscal agent to receive and administer any funds resulting from a successful grant application. If this applies to you, please enter the name of your fiscal agent here, and be sure to describe the relationship between your organization and its fiscal agent in your proposal narrative. PLEASE NOTE THAT THE FISCAL AGENT CANNOT BE AN INDIVIDUAL." |
| Whom would a potential grant check be made out to: |
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Please provide in 1000 characters or fewer a description of your organization. If your form has spaces in it, use your backspace key to return the character count to zero (0).
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| Please describe in 1000 characters or fewer the leadership structure of your organization. For example, is there a Board of Directors or Advisors? How many members are in your group, and what communities do they represent? How are these members admitted to your group and where does any necessary funding come from? Please also provide the names and contact details for two other people involved your group. |
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| Please list the community or communities that will benefit from the proposed project, and provide the population of each of these communities. |
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| Please describe in 3000 characters or fewer the project you propose to implement with support from the Community Catalyst Fund, including a simple itemized budget indicating how the funds would be spent. |
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| Please describe in 1000 characters or fewer the measurable outcomes you hope to achieve with this grant and how it will support sustainability in your community. |
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| Do you have any connection with Clean Air-Cool Planet or the Overbrook Foundation that might give cause for concern about a conflict of interest? If so, please explain (300 characters). |
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| Please enter any additional information that you think would be useful to us in reviewing your request (1,000 characters). |
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| "If you would like information on the Community Catalyst Fund sent to a friend or colleague, please enter their information here". |
| Friends's Full Name |
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| Friends's Email Address |
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