Grant Full Application

Step 1 of 3

Organization Name(Required)

Federal EIN(Required)

Organizational Questions

What makes your organization unique?(Required)

Provide a brief summary of your organization’s history and track record of success.(Required)

(limit of 1000 character count)

Provide a list and brief description of your organization’s current programs and their impact/outcomes.(Required)

(limit of 1000 character count)

How many full-time employees do you have?(Required)

How many part-time employees do you have?(Required)

How many volunteers do you have?(Required)

Does your organization have an endowment and if yes, what is the value?(Required)

Please attach a list of board members including board position held, professional affiliation, county, city and state of residence and years served.(Required)

Max. file size: 256 MB.

Do you conduct an annual review or evaluation of your Executive Director? What method of evaluation is used?(Required)

Is there litigation pending or threatened against your organization? If yes, please provide details including any recent judgments within the last three (3) years.(Required)

Please provide insurance coverage information and all insurance certificates for your organization. List all lines of insurance coverage including policy numbers and policy periods, dollar amounts of coverage per category, and deductibles per category.(Required)

Project / Program Questions

One of the goals of Impact100 Fannin County is to make a sustainable impact in our community, one grant at a time. How does your grant request help us meet that goal? What is the sustainable impact of your project / program and how is it impactful to our community?(Required)

Please state the need your project or program will address and provide evidence of that need.(Required)

How does your project / program address this identified need?(Required)

Why is your organization qualified and appropriate to address this need or provide the desired benefit?(Required)

Describe how or why you selected this project/program and how it fits into your organizational mission. Do you know if this need is currently being addressed by another organization? If yes, please provide additional information.(Required)

Please describe the target population of the project / program and your criteria for inclusion.(Required)

Please provide the project / program start and end dates along with any other significant project milestone dates.(Required)

Please identify the number of clients expected to be served each month and over the duration of the project/program. Estimate the number of direct and indirect recipients the project/program will serve.(Required)

What are the planned project / program outcomes and how will they be measured?(Required)

Describe your plans for the sustainability of this project / program. What are future funding plans to assure ongoing operations?(Required)

Please attach the qualifications/bio of key staff responsible for this project / program.(Required)

Max. file size: 256 MB.

What are the contingency plans if actual costs are not consistent with your budget?(Required)

Is there additional information about the project / program, or changes to your originally submitted Letter of Intent not addressed in the project budget spreadsheet, that you would like to share with us? Any change must be fully explained and supported with documentation. Changes should not be material.(Required)

Do you have permits, contracts, vendor bids or proposals, drawings, leases, site plans, etc. for a project / program that includes a capital improvement?(Required)

If yes, please attach supporting relative information. It should be no more than six months old. NOTE: Leased property improvements must be supported with documentation confirming there is a minimum of five years remaining on the lease as of July 1 of the current Impact Award year.(Required)

Max. file size: 256 MB.

Please list the names of the Executive Director and Board President who have read and approve the following statement: Our organization and Board of Directors authorize submission of this proposal. Our tax-exempt status under IRS Section 501(c)(3) has not been revoked or modified. We understand there is a Terms of the Grant Agreement and, should an award amount from Impact100 Fannin County be received, agree to follow its terms and conditions. We certify that to the best of our knowledge, the statements contained in this application are accurate and complete.

Executive Director(Required)

Board President(Required)

Financial Questions

Please attach the organization's current year to date financial statements with budget.(Required)

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Max. file size: 256 MB.

Please attach the last full fiscal year’s internal financial statements including budget.(Required)

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Max. file size: 256 MB.

If available, please attach three (3) years audited financial statements.

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Max. file size: 256 MB.

If audited financial statements are not attached, please attach three (3) years of internal financial reports.(Required)

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Max. file size: 256 MB.

Share financial statements and IRS form 990 submissions for the calendar years 2020, 2021, 2022.(Required)

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Max. file size: 256 MB.

Provide your overhead cost ratio. (Please see note at the end of this document for a full definition of how to calculate your ratio.)(Required)

Please attach the organization’s most recent Annual Report (if available).

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Max. file size: 256 MB.

Please list your organization’s top five funding sources and amounts for the previous fiscal year.(Required)

If your organization serves a community greater than Fannin County, please explain how you will account for and track grant money to assure it is spent within Fannin County.(Required)

If your grant request will cause your operating expenses to increase on a go-forward basis, for example hiring additional staff, please explain how you plan to offset this with additional revenue after the Impact100 Fannin County grant has been exhausted.(Required)

Please provide additional information to explain any non-recurring revenue or expense of $10,000 or greater and how it may impact ongoing operations. For example, a donation of $10,000 or greater, how will your organization replace this revenue going forward?(Required)

Definition of Overhead Cost Ratio calculation

Your expenses should be classified as Administrative, Fundraising and Program Expenses.

Program Expenses are those directly related to providing your service. For example the cost of books if you teach literacy.

Administrative Expenses are those related to the operation and management of your nonprofit. While essential, they are not directly related to your mission. Examples include meeting costs, insurance and accounting/bookkeeping.

Fundraising expenses may include postage and printing costs for donor letters, event costs, and costs associated with keeping donor and supporter lists.

Overhead Cost Ratio Calculation – Administrative Expenses + Fundraising Expenses divided by Total Expenses (which is Administrative + Fundraising + Program Expenses).