COMMUNITY FOUNDATION OF THE VIRGINIAS, INC.

P. O. Box 4127 – 128 North Street - Bluefield, WV 24701 – Phone 304-324-0222; Fax 304-324-7716

http://cfvinc.org

GRANT APPLICATION COVER SHEET

The following information is required by the Community Foundation of the Virginia’s, Inc. Grants Committee for consideration of your grant. Please attach this form to your two-page letter describing your project, and supporting documentation, and mail to the Foundation office, postmarked by June 30, 2006.

Organization Name _________________________________________________________________

Address __________________________________________________________________________

Phone ____________________________________________________________________________

Contact Person ____________________________________________________________________

1. DESCRIPTION OF THE APPLICANT ORGANIZATION

____ a All applicants must be 501(c)(3) organizations or public institutions. A copy of the IRS letter designating the organization as 501(c)(3) tax exempt (not WV Secretary of State letter or FEIN number) must be attached. If the applicant is a public school, written approval of the school’s Faculty Senate and/or Administration must be included. Grant requests that fail to include such approval will not be considered.

____ b. Name, address, and phone number of organization and contact person.

____ c. List of officers and board members.

____ d. Latest annual financial report and/or operating budget.

____ e. Descriptive brochures of promotional literature about the organization.

2. DESCRIPTION OF THE PROJECT

____ a. The specific need to be addressed.

____ b. Significance and particular benefit to the community.

____ c. Goals and objectives and timeline for achievement, including methods to determine that goals have been reached.

____ d. The number of people the grant will impact.

____ e. Names and qualifications of individuals who will carry out the project.

____ f. Please consider this project for the Fund for Mercer County.

3. BUDGET

____ a. Complete budget for the project, including total cost.

____ b. Budget narrative.

____ c. How you propose to fund the project.

____ d. Amount requested from the Community Foundation of the Virginias, Inc.

____ e. Other possible funding sources and amounts.

____ f. At least two (2) price quotes for all services or durable goods to be purchased.

All communications should be addressed to:

Community Foundation of the Virginias, Inc.

P. O. Box 4127

Bluefield, WV 24701