Organization Information

Organization Name:

Address:

City:

State:

Zip code:

Telephone:

email Address:

Website (Optional):

Name/title/contact information of representative:

How long has your organization been in existence?

What are its other sources of funding (government grants, corporate support, individual donations)?

Summarize your organization’s mission and the clients/community it serves:

List your organization’s governing board, officers, key staff and any ad hoc or advisory committee members (or attach list to this application):

Optional Board File Upload:

Project Information

Project title:

Area and client group to be served:

Anticipated project duration (Is it already underway? How long will it last?):

Project description (include what kind of support exists for this project, the needs it will serve, and how the requested funding from YCCF would be used)::

Requested funding amount (USD)*:
(*Please attach the planned budget for the project.)

Financial and Legal Information

Please provide a copy of your organization’s most recent financial statement:

Is your organization tax exempt under the IRS Section 501(c)(3) or a unit of local government (e.g., school, library)?
 Yes No

If yes, please provide a copy of your Internal Revenue Service determination letter.

If no, please provide the name and contact information of the person who will be responsible for accounting expenditures, or what 501(c)(3) will act as the fiscal sponsor.)

Checklist

Be sure you have attached:

• A copy of 501(c)(3) designation letter above
• A copy of most recent financial statement above

Please enter the characters from the image above into the following form:

Note: File uploads take a moment or two to process. You will see a "thank you for your submission" screen and receive a confirmation e-mail after your application has successfully uploaded.