Green Mountain United Way Community Grant Funding and Micro Grant Funding Application Form

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1 INTRODUCTION Thank you for your interest in Green Mountain United Way s (GMUW) Grant Funding. GMUW is proud to offer funding opportunities to area non-profit agencies and understands the vital role these organizations play in maintaining the well-being of our communities. Our current grant opportunities include Micro Grants in an amount not to exceed $ and Community Grants in an amount not to exceed $2, The Mission of GMUW is Mobilizing communities to create lasting changes in local conditions that will improve lives. It is our belief that everyone deserves the opportunity to have a good life through a quality education that leads to a stable job, sufficient income to support a family, savings for emergencies and comfortable years of retirement, and to have and maintain good health throughout their lives. ELIGIBILITY To apply, all eligibility items must be met: 1. Organization is located in Vermont and currently tax exempt under 26 U.S.C. 501 (c) Organization is governed by an active volunteer Board of Directors. 3. Project outcomes are aligned with Green Mountain United Way s priorities of Health, Education or Income as referenced in our Mission Statement above. 4. Grant activities occur between November 2015 and March Specific dates for both Micro and Community Grants application submission and award notification are listed on the Green Mountain United Way grant application form. 5. Grant funding will be utilized in one or more of the following counties: Washington, Orange, Caledonia, Essex, and/or Orleans. 6. Community Grant funds are only used for project staff salaries, consultant fees, operation expenses and direct project expenses. The grant funds shall not be used for fundraising activities or salaries of staff not involved with the project. 7. Micro Grant funds shall be applied directly to the physical needs of the project. GRANT APPLICATION The same grant application document may be used for either the Micro Grant or the Community Grant. The application may also be found on the GMUW website: Green Mountain United Way encourages the electronic submission of grant applications. Electronic submissions can be sent to October 2015 Page 1 of 5

2 HOW TO SUBMIT YOUR REQUEST For those applying for either the Micro Grant or Community Grant, please complete Part A and Part B. Only those applying for Community Grant funds should complete all sections, including Part C. Save your completed application with a file name beginning with the organization name, followed by the project name. For example; Organization_Project.doc. your completed application to If electronic submission is not possible, please mail a hard copy to: Green Mountain United Way Caledonia/Southern Essex Office Att: Nelson Baker, Community Impact Director 1325 Main Street St. Johnsbury, VT Multiple Community Grant requests and Micro Grant requests from one organization within a 12 month cycle will not be considered regardless of the number of programs you run, so please consider the scope and timing of your request. APPLICATION TIME LINES Grant Category Micro Grant Request at or below $250 Community Grant Request at or below $2,500 Open Invitation To Apply Round 1: Oct. 15, 2015 Round 2: Apr. 4, 2016 Round 1: Jan. 4, 2016 Round 2: July 8, 2016 Application Deadline Round 1: Nov. 15, 2015 Round 2: May 6, 2015 Round 1: Feb. 1, 2016 Round 2: Aug. 5, 2016 Award Notification Round 1: Nov. 25, 2015 Round 2: May 16, 2015 Round 1: Feb. 15, 2016 Round 2: Aug. 15, 2016 QUESTIONS? For additional questions or information, Nelson Baker at October 2015 Page 2 of 5

3 PART A Date: Organization Name: Mailing Address: Website Address: Executive Director: Board President: Name/Title of Individual Completing Form: Phone Number: Address: Annual operating budget: $ Number of Paid Employees: A Vermont tax exempt 501 (c) 3 non-profit organization may apply for a Micro Grant not to exceed $ or a Community Grant not to exceed $2, What is the type of grant and amount of your request? Under which priority are you applying (Health/Income/Education)? What is the specific project for which you are requesting funds? PART B 1. What is your organization s mission? (50 words or less) 2. Is the organization located in Vermont and currently tax exempt under 26 U.S.C. 501(c)(3) Yes, tax ID#: Include a scanned copy of your 501(C) (3) certificate with your application. October 2015 Page 3 of 5

4 3. How much grant funding in each year listed has your organization received from Green Mountain United Way (please understand that past support does not guarantee future support): 2015 $ 2014 $ 2013 $ Other 4. How many people do you anticipate will be served by this project in the following counties served by GMUW? Washington Orange Caledonia Essex Orleans 5. If your request is approved, please check at least one way that Green Mountain United Way will be recognized? GMUW logo on your printed or electronic marketing materials Press releases Social Media List GMUW as a funder on organization website and in Annual Report Other (please specify) Micro Grant Applicants proceed to signature block on next page. Please continue to Part C ONLY if you are an applicant for Community Grants. PART C Community Grant Qualifications Please indicate that the organization and project are eligible to receive Green Mountain United Way funding by checking the lines below: Project funding is utilized in one or more of the following counties: Washington Orange Caledonia Essex Orleans Requested amount is $2, or less for a Community Grant. Minimum of 50% of the total amount requested is matched by other revenue sources and/or in-kind donations for a Community Grant. Community Grant funds are used for project staff salaries, consultant fees, operating expenses and direct project expenses. GMUW does not support fundraising activities and salaries of permanent staff not involved with the project. October 2015 Page 4 of 5

5 Please submit the following materials and check each line to indicate that the documentation is included: Project narrative which should include what you expect to achieve and how you will measure your success and the manner in which it relates to our outcome priority areas of Health, Education or Income. Project budget Most recent Annual Report to include a list of the Board of Directors, financial summary and description of organization activities. We, the undersigned, do hereby agree to the terms as stated in the grant application document and do certify that the information provided in this application and in the attached supporting documents are true and correct to the best of our knowledge. Signature of Executive Director/CEO Printed Name Date Signature of Board President Printed Name Date Thank You. October 2015 Page 5 of 5

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