Email: *
Grant Program: (Check Only 1 Program. Refer to Guidelines.) *
BDE
ETCCS
YSRS
CII
SAS
CAS
Mini Grant
Other
Grant Number: (TO BE ASSIGNED BY EBF)
Amount Requested: (SEE GUIDELINES FOR MAXIMUM GRANT) Dollar Amount = $ *
Program or Project Title: *
Total Program and Total Project Budget: (including grant amount requested) Dollar Amount = $ (Please fill out a budget form for total program and budget form for the proposed program/project) *
Portion sought to be covered by EBF grant request: (SEE GUIDELINES FOR MAXIMUM %) *
Agency/Organization Name: *
Street Address: *
City, State & Zip Code: *
Phone Number: *
Contact Name & Title: *
Contact Person Phone Number: *
Summarize the organization's mission (2-3 sentences) and state year founded: *
Summary of project or grant request (2--3 sentences): *
Is your organization an IRS 501(c)(3)? (Tax-exempt organizations are not necessarily 501(c)(3)'s-include IRS Exemption Determination Letter. NOTE: If the applicant is not a 501(c)(3), then it must partner with an exempt organization to serve as its fiscal agent. *
YES
NO
EIN#/Taxpayer ID#
Authorized Signature: (Type in name & check I Agree below) *
Date: *
Please continue on with more information below in form: 1. With respect to the funding requested, please identify from the following categories the type of programs or initiative that will most likely benefit from such a grant (Please refer to Guidelines and choose only one of the following)*
A.Child-Care/Early Education
B.Elementary Education
C.Secondary/High School Program
D.Summer/After School Program
E.Senior Citizen/Adult Education/Recreation
F.ESL Instructor
G.Community/Cultural Event (Seasonal)
H.Community/Cultural Event (Year Long)
I.Sports Recreation Program (Participants Over 16 Years of Age)
J.Sports Recreation Program (Participants 16 Years of Age or Under)
K.Business Development/Seminars
L.Capital Improvement/Community Beautification
M.OTHER/NOT LISTED
Explain Above: M. OTHER/NOT LISTED
2. Describe your specific program, project or initiative and the geographic area your proposal would most likely benefit. If your project, program or initiative is being run or is proposed to run out of a physical location please specify that location. (i.e. East Boston only, 50% East Boston.) *
3. Describe specifically what aspects of your program you seek funding for and the percentage o the proposed foundation grant you seek to allocate to each area. (i.e. staff, supplies, operating expense, etc.) *
4. Describe the overall goals and objectives of your proposal and how your proposal will help to enhance the mission of your organization. If applicable, please also specify the number of East Boston residents that participate in the program or that you anticipate will participate in the program. (i.e. the specific types of services to be provided , the number and types of persons to be served.) *
5. Please describe whether this program, project, or initiative is currently in existence, and if so for how long? If this is a new program, please describe the projected longevity of your program and your fundraising objectives/strategy. *
6. If your organization provides similar services as compared to other programs, initiatives and other organizations already in existence (either within or outside the East Boston community) describe how your organization will ensure that there will be no unnecessary "overlap" of efforts and resources. *
7. Describe your organization's experience/capacity to complete the proposed project or implement the proposed program. *
8. Describe what additional sources of revenue/funding your program has relied upon in the past; will rely upon in the future; whether there has been or will be a significant change in these sources (either positive or negative) and the reasons for such a change, if any. *
9. Please describe the specific need for this program, project, or initiative within the community and how the requested expenditure will ensure that the need is met.*
10. Describe the means and levels of financial assistance, if any, you intend on providing to disadvantaged individuals who wish to participate. (If applicable)
11. What efforts has or will the organization undertake to promote this program and ensure that the benefit conferred by the Foundation is accessible to as much of the East Boston community as possible? *
12. Describe how this program or initiative helps to either directly or indirectly reduce impacts of Logan Airport on the East Boston community. Please provide examples. (Please note this MUST be answered or your application will NOT be accepted.) *
13. Please identify the organization's three (3) largest sponsors or donors the past three (3) years, the amounts contributed by each sponsor or donor, and the restrictions (if any) on such contribution or donation and whether such donor is contributing to this project or initiative. *
14. Please list the total amount of contributions received from the East Boston Foundation for each of the past five (5) years. *
15. In the event that a grant from the Foundation is not approved under this request, please state whether this project or initiative will continue. *
