Program Grant Application

Transcription

1 Program Grant Application Northern Lights Hockey Foundation Mission: The promotion of amateur sports competition in the game of hockey in the tri-state area of Iowa, Illinois and Wisconsin with a particular emphasis on physical education, character development, and education. Deadline: This application must be turned in by March 30, Application Information Grant applications must be submitted by March 30, Mailing: Mailed applications must be postmarked by March 30, Northern Lights Hockey Foundation Program Grant Application 1800 Admiral Sheehy Dr. Dubuque, IA Hand-delivery: Hand-delivered applications must be handed to the Dubuque Fighting Saints by March 30, 2018.

2 The Dubuque Fighting Saints office is located on the second floor of the Mystique Community Ice Center. The offices are open 9 a.m. to 5 p.m. Monday through Friday. Please call if you have any further questions. Grant applications must be fully filled out and meet the grant criteria checklist to be considered. Grant Criteria Proceeds from the Northern Lights Hockey Foundation 5050 raffle at Dubuque Fighting Saints games and other Foundation fundraising efforts and donations will be awarded through grants to local non-profit organizations. All grants will be awarded for projects that advance the Northern Lights Hockey Foundation mission. The primary objective of the Northern Lights Hockey Foundation is the promotion of amateur sports competition in the game of hockey with a focus on: o Physical Education: Organizations that promote physical education and the benefits of living an active lifestyle, particularly in youth. o Character Development: Organizations that promote character development by making the right choices that will help individuals reach their full potential, and creating well-rounded individuals. o Education: Organizations that promote the value and importance of inschool and after-school programs that will encourage a positive lifestyle for all children, and a path in which school plays a primary role in the lives of youth. Northern Lights Hockey Foundation representatives will review the submitted grant applications. Grant applications must be complete and meet the above grant criteria and final decisions will be made by the Northern Lights Hockey Foundation. Declined grant applications should not be viewed as a reflection on the organizations merit, mission, or programs.

3 Grant Application Summary: A TOTAL OF SIX (6) PAGES MUST BE COMPLETED AND SUBMITTED TO BE REVIEWED. Page One Signed Application Page Two Grant Application Summary This summary must be one (1) page in length and should be a brief summary of your grant proposal so that it can act as a standalone grant application if necessary. 1. Organization name 2. Project/Program name a. One sentence summary of the grant application 3. Summary of your grant request a. What is the community need being fulfilled b. What services will be provided c. Explain how this constitutes an urgent need d. How will the Dubuque Fighting Saints and the Northern Hockey Lights Foundation be recognized as a grantor e. Do you have volunteer or Board opportunities available Page Three Program Budget 1. Provide a descriptive budget for only your program or project (not organizations complete budget) 2. If required, list the addition sources of funding needed. Page Four Signed Certification of Tax Exempt Status of Grantee Organization Page Five Copy of IRS letter Page Six List of current Board of Directors

4 Page One Application Name of Organization: Organization Contact: Title: Address: Mailing Address: City: State: Zip Code: Physical Address: City: State: Zip Code: Telephone: Fax: Organization Website: Federal ID Number: Date Established: Do you have an internal relationship with a Dubuque Fighting Saints or Northern Lights Hockey Foundation employee, if so, who?: Organization Mission Statement: Summary of program/project: Category of Service (Circle ONE): Physical Education Character Development Total operating budget for current year $: Date of fiscal year end: Number of youth affected by this grant: Total funds requested: $ Education The undersigned hereby certifies that the information provided in this grant application, is true, correct and complete as of the date of submission. This undersigned further understands that falsification and/or omission any facts in this application may be cause of disqualification and or other remedies under Iowa law. Signature of Authorized Representative Name (Print) Date Title

5 Page Two Program/Project Summary This should be a one (1) page summary of your grant application which could be used as a standalone application if necessary. Organization name: Summary for your grant request: What is the community need being fulfilled with the grant: What services will be provided: Explain how this is an urgent need: Where will the work/services funded by the grant be provided: How will the Dubuque Fighting Saints and the Northern Lights Hockey Foundation be recognized as a grantor: Do you have volunteer or Board opportunities available:

6 Page Three Program/Project Budget Provide a descriptive budget for only your program or project (not organizations complete budget): If required, list the addition sources of funding needed:

7 CERTIFICATION OF TAX EXEMPT STATUS OF GRANTEE ORGANIZATION I, an Officer/Director of (Organization) Hereby certify that the organization has received a ruling from the Internal Revenue Service that it is exempt from federal income tax under Section 501(c)(3) of the Internal Revenue Code. I further certify that said exemption rulings from the Internal Revenue are still in effect and have not been revoked or amended. (Signature) (Printed Name) (Title) (Date)

8 Grant Application Checklist Each grant application must include the pages provided below and also be in order: 1. Signed Application 2. Program/Project Summary 3. Program/Project Budget 4. Signed Certification of Tax Exempt Status of Grantee Organization 5. Copy of IRS letter 501(c)3 6. List of current Board of Directors