Grant Letter of Intent

Organization's Name(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Website(Required)

Contact Name(Required)

First Last

Email(Required)

Phone(Required)

Year Founded(Required)

Federal EIN(Required)

Organization’s mission statement(Required)

Provide a copy of the organization’s federal IRS determination letter documenting 501(c)(3) public charity status.(Required)

Max. file size: 256 MB.

Total operating revenues for the last full fiscal year.(Required)

List any previous years your organization submitted an Impact100 Fannin County Letter of Intent and/or Grant Application and whether a Grant was awarded.(Required)

State the Focus Area for which you are applying. (Arts & Culture; Education; Environmental; Recreation/Preservation; Family; or Health & Wellness)(Required)

Grant project or program title and type (e.g., new, existing, expansion, etc.)(Required)

Total grant project or program budgeted amount.(Required)

Complete and attach the Impact100 Fannin County provided Budget spreadsheet.(Required)

Please do not submit a modified version of this spreadsheet. You can download the template spreadsheet by clicking here.

Max. file size: 256 MB.

Provide the organization’s most recent income statement, balance sheet, last three (3) 990 IRS submissions and last three (3) bank statements.(Required)

Drop files here or

Max. file size: 256 MB.

Confirm the project or program services will occur within the limits of Fannin County, Georgia.(Required)

Please select the grant amount for which you are applying:(Required)

Describe in a few sentences the project / program(s) for which you request funding. (Propose a new project / program or expansion or continued support of an existing, proven project.)(Required)

(Character count limit is 500.)

Describe how this grant project / program would significantly impact the organization and the people/community served.(Required)

(Character count limit is 1000.)

For projects involving capital expenditures or improvements, confirm the organization owns the property involved or have a long-term lease in effect as of the Letter of Intent due date with a minimum of five years remaining on the lease as of July 1 of the Impact Award year. If applicable, please provide documentation confirming ownership of the property, or of the lease.

Drop files here or

Max. file size: 256 MB.

Acknowledge all grant funds will be used within 24 months of January 1, 2024.(Required)

Please provide Executive Director’s approval with the following dated and signed statement on your organization’s letterhead and attach to the completed Letter of Intent: "I certify that this organization is an IRS 501(c)(3) organization and our tax-exempt status has not been revoked or modified. I certify that I have reviewed this application along with the Impact100 Fannin County Eligibility guidelines prior to submission, and the information provided in the application is accurate and verifiable."(Required)

Max. file size: 256 MB.