2018 Marble Easter Offering Grant Application. NAME OF ORGANIZATION: (501)(c)(3) entity Yes No AMOUNT OF REQUESTED GRANT: $10,000 ; $5,000 ; $2,500

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1 Marble Easter Offering Grant Application Please complete and provide information and documentation for Section I Section XV and submit online to Easteroffering@marblechurch.org with the heading 2018 Easter Application by February 26, The completed application form should be no more than eight pages. A hard copy of Section I Section XV which includes all supporting materials should be mailed to Easter Offering Application 2018, Marble Collegiate Church, Attention: Susanah Wade, 1 West 29 th Street, New York, NY NAME OF ORGANIZATION: (501)(c)(3) entity Yes No REFERRED BY: RELATIONSHIP WITH MARBLE (IF ANY): AMOUNT OF REQUESTED GRANT: $10,000 ; $5,000 ; $2,500 AREA TO BE FUNDED: Health ; Shelter ; Education ; Social or Legal Services I. Organization and Contact Information/Overview of Need (If applicant organization is part of a larger tax- exempt organization, please provide information for that organization, as well as the grant- seeking entity. Address: Phone: Webpage: Year Founded: Purpose of Funding (check one): Project/Program Operating Funds Name of Umbrella Organization (if applicable and if umbrella organization has (501)(c)(3) status): Name/Title/ /Telephone # of contact person: CEO/Executive Director Phone: Cell Phone (if needed for contact):

2 2 Brief statement (two/three sentences) of professional qualifications/experience: If requested grant is for a specific project or program, provide the following: Project/Program Director: Title: Phone Number: Cell Phone (if needed for contact): E- mail: Brief statement (two/three sentences) of professional qualifications/experience of Project/Program Director: II. III. IV. Organization s Mission Statement (two- three sentences): Purpose of Requested Grant: Brief, One- paragraph Statement of Purpose for Grant: V. Brief Portrait of Organization Finances: Fiscal 2017 Revenues: Expenditures: Fiscal 2016 Revenues: Expenditures: Fiscal 2015 Revenues: Expenditures: Listed on Charity Navigator website (recommended) Yes No COMPLETE EITHER SECTION VI OR SECTION VII. VI. If for general operational support, please describe the following: A. Time period during which funds will be used: B. Number of people expected to benefit from funding per year: C. Description of the target population who will benefit from funding: D. Geographic area (s) in which funds will have an impact: E. Brief statement of organization s qualifications for, and expertise and experience in implementing its mission: F. Brief, one- paragraph case study or story about a program s impact: VII. If for specific project, please describe the following: A. In two sentences, describes the project/program for which Marble s funding is intended: B. Geographic area (s) in which project/program will operate:

3 3 C. Date on which the project/program was first established: D. Budgeted total cost of the project/program for the upcoming fiscal year: E. The actual total cost of the project/program in the previous fiscal year (if applicable): F. Number of people expected to benefit from the project/program per year: G. Description of the target population who will benefit from your project/program: H. A brief, one- paragraph case study or story about a program beneficiary which will help the Marble Benevolence Committee understand the project/program s impact: I. Brief strategy for implementing the project/program and expected accomplishments or milestones: J. Brief statement of organization s qualifications for, and expertise and experience in implementing this project/program: K. How will you define and measure the project or program s success: VIII. Recent and Current Significant Changes in Areas Below A. Organization leadership: B. Organization staffing: C. Financial condition of the organization, including funding: D. Programs added or stopped: E. Challenges facing the organization: IX. Comparison to Similar Organizations A. What distinguishes your organization from others that pursue the same or similar goals: B. How does your organization complement or collaborate with the work of other organizations with the same or similar goals: X. Administration and Staff A. Board of Directors 1. Board Chair: 2. Role of Board: 3. How frequently does Board meet:

4 4 4. Describe any requirements for Board members to provide financial or other support to your organization (e.g. Get/Give policy): 5. Financial support provided by Board over last two fiscal years: B. Staffing 1. Describe any changes in the organization s leadership over the last two fiscal years: 2. How many full- time staff employees does your organization employ: 3. Number involved with programs ( Percentage of overall staff %) 4. Number involved in administration ( Percentage of overall staff %) 5. If your funding request is for a specific project or program, how many full- time staff will be necessary to run the project: XI. Volunteer Involvement A. To what extent do you depend on volunteers: B. If application is for a specific project/program, volunteers that will be needed for the project/ program: C. Is there any role or need for volunteers from Marble Collegiate Church: XII. Organization s Funding Sources A. On average over the last two fiscal years, percentage of organization s total funding that comes from: 1. Government grants: Federal % State % Local % 2. Private Institutions: Corporations % Foundations: % 3. Churches: % 4. Individuals: % 5. Endowment: % 6. Other % B. Previous Funding from Marble Easter Offering: 2017: $ 2016: $ 2015: $ 2014: $ 2013: $ XIII. Administrative Costs A. Calculation of organization s expenses as a percentage of its total operating budget: Program `% Administrative % Fund Raising %

5 B. Brief explanation of the components of these calculations, (i.e., what you include in your definition of administrative expenses.) C. Annual salary of highest paid administrator: $ 5 XIV. Required exhibits to be attached to mailed application. (Application cannot be processed without this information.) A. Applicant s IRS tax exempt designation letter (501)(c)(3). B. Applicant s last two years audited financial statements. C. Applicant s last two years of filed Form 990. D. Applicant s operating budgets for current and previous year. E. Applicant s latest annual report. F. Applicant s program budget for current fiscal year and two previous years. G. List of applicant s primary funding sources for the last two fiscal years. H. Bios/Resumes of the applicant s Executive Director or Chief Executive Officer, and, if the grant is for a project or program, the head of the project or program. Bios/Resumes of other key employees may also be attached if helpful in understanding the project/program. I. List of Names of Board members and organizations with which they are affiliated. J. Any additional materials that will help the committee better understand the applicant, including a longer description of the program to be funded and its operation. K. Visual materials such as a photo/photos or brief video showing the project in operation if available. (Marble may seek permission to use visuals in promotion of the Easter Offering.) L. If a for- profit/social enterprise operating model constitutes part of the 501(c)(3) organization, all requested information and supporting documentation (including financial reports, list of board members and executive officers etc.) must be provided for both parts of the operating model. XV. RELEASE (Application will not be accepted for processing without the required signature below) I understand that, should my organization be approved for a grant, by submitting this grant application we give Marble Collegiate Church permission to include my organization's name and logo in referring to current, prospective and former grantees in future communications and materials worldwide in any media (now known or later invented or discovered), including, but not limited to, press releases, newsletters, brochures, in- person, broadcast and online communications, and social media (i.e. Facebook, Twitter, YouTube, etc.). *I have read and I agree to the release above.

6 6 Signature: Printed Name: Date: