2024 Combined Grant Application All applications must be postmarked by September 1, 2024 Call (304) 872-0202 or email the Foundation at [email protected] with any questions. 2024 Combined Grant Application "*" indicates required fields If you have questions or encounter problems while completing your online NCCF grant application, please contact the NCCF Executive Director, Tamara Mullins, at [email protected]. Grant applications must be submitted online, not emailed and no paper copy mailed please.Nicholas County Community Foundation Combined Grant ApplicationOrganization:* Date Established:* Phone*Address of Organization:* Street Address City State / Province / Region ZIP / Postal Code Fiscal Agent/Treasurer:* Email:* Project Director:* Email:* Organization's Annual Budget:* Project Amount Requested (no greater than $10,000):* Project Start Date:* MM slash DD slash YYYY Project End Date:* MM slash DD slash YYYY Area to be Served:* Number of persons to be served/ Target Population:* Title of Project:* Project Purpose: (Briefly summarize the goals and outcomes of this project. Do not exceed the space provided, approximately 200 words)*Assurances The Applicant hereby assures Nicholas County Community Foundation that: 1. The program will comply with all state statutes and federal law. 2. Appropriate records will be provided to the Nicholas County Community Foundation as needed for fiscal audit and program evaluation. 3. The tax-exempt status of this organization is still in effect. 4. This organization or any of its members has not within a three-year period preceding this application been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property. 5. This organization or any of its members is not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in item 4. 6. This organization or any of its members has not within a three-year period preceding this application had one or more public transaction (federal, state, or local) terminated for cause or default. 7. The applicant certifies that no grant funds will be used to purchase alcohol or tobacco. 8. The applicant does not discriminate on the basis of race, color, national origin, gender, age or disability. 9. All facilities utilized by the applicant for grant purposes will be accessible to people with disabilities. 10. All notices and invitations to the grant-related events will bear language to the effect that accommodations will be available at the request of the participant. All reasonable accommodations will be made to maximize participation. 11. Organization will submit a final grant report to the Nicholas County Community Foundation on May 1 of the year following the award. Organizations will be prohibited from applying for future NCCF grants if a final report is not submitted.Fiscal Agent’s/Treasurer’s Printed Name* Signature* You are consenting that your typed name will be your signature.Date* Project Director’s Printed Name* Signature* You are consenting that your typed name will be your signature.Date* A. Purpose of grantSpecify the need addressed by the project and describe its significance to the community and its proposed benefit.*Does this project provide a unique service?*Provide a project schedule (including a timeline for implementation and completion of the project.)*Describe the project’s proposed measurable outcomes. Outline your plan to document progress and results. How will you measure expected outcomes and the effectiveness of your activities?*B. Budget and Budget NarrativePlease explain your organization's financial need for this project.*If the Nicholas County Community Foundation is not funding your entire project please briefly explain your other sources of funding for this project.*List and itemize all expenses related to your project/grant request.*Budget Item$ AmountFunding Source Add RemoveTotal Project Budget $* Total NCCF Request $ (no greater than $10,000)* Additional attachments to be included:* Verification of tax-exempt status or IRS Letter of Designation Upload Files* Drop files here or Select files Max. file size: 100 MB. Letters of support If your project involves working with another organization or institution, you are required to submit a letter of support from that organization or institution (if applicable). Upload Files Drop files here or Select files Max. file size: 100 MB, Max. files: 10. CAPTCHAPlease check your junk folder if your notification does not arrive in your inbox.
