EmailMe Form - M&M Area Community Foundation Grant Application

1.1 Please select the grant cycle for which you are applying. *
Youth Advisory Committee - OPENS 2016
Community Wide - OPENS 2016
Health - OPENS 2016
Women's Giving Circle -OPENS 2016
Alcohol & Other Drug Abuse - OPENS 2016
Peshtigo Area Foundation - OPENS 2016
CURRENTLY NO GRANT CYCLES ARE OPEN
Grant Guidelines can be found here -> http://www.mmcommunityfoundation.org/grant-guidelines

Call our offices at 906 864 3599 for additional information.
1.2 Today's Date *
MM / DD / YYYY
1.3 Name of Organization *
1.4 Executive Director *
1.5 The Organization is... *
a registered 501(c)(3)
a department of a municipal, county or state government
a hospital, school (public or private), or department / program thereof
Pick the answer that best describes your organization.
1.6 Principal Mailing Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
1.7 Phone *
### - ### - ####
1.8 Contact Person For Project *
1.9 Contact's Email Address *
1.10 Project Name *
1.11 Purpose of Grant *
Please limit description to 100 words or less.
1.12 Project Start & End Dates
Leave blank ONLY if project is ongoing.
1.13 Total Cost of Project *
$ Dollars . Cents
Cents are not required. Please round up to nearest dollar.
1.14 Funds Requested *
$ Dollars . Cents
Cents are not required. Please round up to nearest dollar.
1.15 Board Chair or President
First Last
2.1 Geographic Area Served By Project *
Amberg Area
Athelstaine Area
Coleman Area
Crivitz Area
Daggett Area
Marinette Area
Menominee Area
Niagara Area
Pembine Area
Peshtigo Area
Pound Area
Powers Area
Stephenson Area
Wausaukee Area
Click all that apply. Multiples are possible.
2.2 Project Overview
Please include paragraphs for:

1. Executive Summary
2. Describe project goals and objectives and how they will be measured
3. Is this a new or ongoing project? Describe.
4. Explain your plan to accomplish your goals and objectives for this project.
5. Are there other partners in this project? Explain.
6. If you are not granted full funding, you you have a contingency plan? Describe.
3.1 IRS form 990
Please attach a pdf of your organization's most recent IRS form 990 (pages 1 and 2).

If these forms are not available, please attach a document that explains this.
3.2 Project Cost Overview
Please attach a document with budget information for the project in this order.

NOTE - This should NOT include your organization's operating budget, but should be specific to the project named in 1.9

1. Salaries
2. Payroll Taxes
3. Fringe Benefits
4. Consultants
5. Insurance
6. Travel
7. Equipment
8. Supplies
9. Printing & Copying
10. Telephone / Fax
11. Postage Delivery
12. Rent
13. Utilities
14. Maintenance
15. Evaluation
16. Marketing.
17. Other
18. Total Project Costs
3.3 Project Revenue
Include the total amount for each of the following budget categories, in this order, indicating which sources of revenue are committed and which are pending.

Grants / Contracts / Contributions

1. Local Government
2. State Government
3. Federal Government
4. Foundations (Please itemize)
5. Corporations (Please itemize)
6. Individuals
7. Other (Specify)

Earned Income

8. Events
9. Publications & Products

10. Membership Income
11. In-Kind Support
12. Other (Specify)

13. Total Revenue

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