Grant Application. Organization Information. Date of Application: Tax ID: Year Founded: Legal name of organization applying:

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1 Grant Application Instructions: Please complete the following grant application and return to the JLF grant department Please allow 6-8 weeks for evaluation. Organization Information Date of Application: Tax ID: Year Founded: Legal name of organization applying: (Should be same as on IRS determination letter and as supplied on IRS Form 990.) Executive Director: Phone number Contact Person Name/Title (if different from executive director): Address (principal/administrative office): City/State/Zip: Phone Number: Address: Organization Mission: Planned Project Start Date: Amount Requested: $ Approval of Executive Director: We approve submission of this grant request and certify that the applicant organization does not discriminate on the basis of race, color, age, sex or national origin. We also certify that our most recent IRS notification of our organization s 501(c)(3) status is attached to this application and that the organization has received no notice from the IRS of any proposal, threat or suggestion to revoke or modify this determination. Executive Director Signature: Date: Executive Director Name (Print):

2 Grant Application Narrative: 1. Is the funding being requested for: New project/program Expansion or improvement of an existing project/program Sustainment of existing project/program 2. Description of project/program (please include long and short term goals and objectives and how this program/project aligns with the mission of The Joey Logano Foundation) (Limit 1300 words) 3. Describe specifically how funding from The Joey Logano Foundation would be used to fulfill objectives for this program/project (limit 500 words) 4. Does the program/project address an emerging community issue? Describe the need and explain how the program/project seeks to address the need (limit 500 words)

3 5. What results are you committed to achieving, meaning change in participant behavior and/or condition, and for how many persons? (limit 1300 words) 6. How will you know when your results have been achieved? What information or evidence will you use to verify success? (limit 1300 words) 7. How will you sustain the program/project once funding from the Joey Logano Foundation ends? (limit 500 words) 8. Will your organization be able to fulfill the following requirements? (Check if yes) Provide stories/updates to The Joey Logano Foundation on program success as requested to be used in foundation communications? Complete an annual report provided by The Joey Logano Foundation? 9. Please list other funders for this program/project (mark C if committed and R if requested).

4 10. Have you applied for funding through The Joey Logano Foundation in the past? No Yes 11. If yes to question 10, please provide the amount and the year you received funding. 12. How did you hear about us? Newsletter Website TV Radio Web Search Other

5 Joey Logano Foundation Grant Request Checklist Please ensure the following documentation is complete and has been submitted to in order to guarantee your request will be reviewed. If your application is missing any of the following items, your request will not be evaluated. Thank you! Completed Grant Application Copy of IRS Determination Letter List of Current Board Members Program/Project Budget Copy of most recent audited financial statement (for applications over $50,000) Please allow 6-8 weeks for review of application. Written communications will be sent out to notify grant award winners. Thank you for your application and we wish you the best of luck.