GRANT APPLICATION
Foundation
for the Enhancement of Mitchell County
% of the Mitchell County
EDC
509
State Street / Osage, Iowa 50461 / 641.732.4790
mcedc@osage.net
Organization
Name
Date
Federal
Tax Identification Number
Address
City
State
Zip
Contact
Person
Position in Organization
Phone
Number
Fax
Number
Project
Name
Email
Amount
of Request $
(min. $500 / max. $5,000)
Letter
of Application
Please
address the following discussion points in the Foundation for the
Enhancement of Mitchell County application, limiting the letter to two
pages (12 font, one inch margins).
1.
Briefly describe the project.
2.
Describe the Community Need/Problem being addressed by this project.
(FEMC goal areas: Life Learning, Environmental Quality, Community
Development, Health & Fitness)
3.
Describe the purpose of the grant and how it will benefit the
community/clients.
4.
Indicate desired outcomes and measurable results. Include how the project
will be publicly communicated and/or recognized.
5. Is
this a one-time project? If not, describe the long-term plan for
sustainability of the project.
6.
Outline collaborating partners for the project; other funding secured,
applied for and proposed for the project. Specify the amount you are
requesting from the Foundation for the Enhancement of Mitchell County and
attach a budget for the project (Please use the form provided).
Final
packet to include:
_____
Copy of current IRS Exemption Letter for the 501(c)(3) nonprofit status? If
no – is your organization a 170b unit of government? If no – you must have a
fiscal agent that is a 501 (c) (3) or 170b– letter from fiscal agent must be
attached with their IRS Exemption Letter to your application. Only 501
(c) (3) and 170b organizations eligible applicants
_____
Signed Application Form
_____
Letter of Application
_____
Project budget/timeline/list of the organization’s Board of Directors (In
attached format)
_____
Submit 13 hard copies of the final packet
The
undersigned certifies that they are authorized to represent the organization
applying for a grant and that the information contained in the application
is accurate. The undersigned agrees that if a grant is awarded to the
organization:
·
the
grant will be used for the purpose outlined in the grant award letter and
may not be expended for any other purpose without prior written approval
from the Foundation for the Enhancement of Mitchell County.
·
the
Foundation for the Enhancement of Mitchell County has received nothing of
material value in exchange for the grant.
·
information about the organization and the grant may be used by the FEMC in
any published materials.
·
the FEMC
requires receipted proof of purchase for grants including photographs of the
completed project. Projects not completed within 12 months are required to
return the unused portion of the grant to the FEMC.
Signature of Authorized Project Representative / TITLE
Right click on the links below and select Print from the drop down menu.
This should send the application and attachment to your printer and begin
printing.
Mitchell County Economic Development Commission
