Louis L and Julia Dorothy Coover Charitable Foundation Regional Grantmaking Program

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1 Charitable Foundation Regional Grantmaking Program Organization Information Primary Organization Name* Character Limit: 250 Mission Statement* Please provide your organization's mission statement. Character Limit: 1000 Year Founded* In what year was your organization founded? Character Limit: 4 Current Programs* Please provide a brief description of your organization's current programs and recent accomplishments. Project Information Project Name* The name of the project is attached to each and every form within your process. This is the "identifier" for the request. Character Limit: 100 Primary Area of Impact* Select the primary philanthropic area your project will impact. Choices Animals Arts and Culture Beautification Community Development Diversity Early Childhood (0-5 years) Education Grantmaking Program 1

2 Environment Health Human Services Senior Citizens Social Justice Youth (6-18 years) Type of Request* Please select the type of request that most accurately fits with your proposed program. Choices New Program Existing Program Expansion of Existing Program General Operating Support Counties Impacted* Please check all counties in which your proposed project would impact. Note that if your agency will not impact any of the counties listed, your project is not eligible for Coover funding. Choices Barry Barton Bates Benton Bolinger Butler Camden Cape Girardeau Carter Cass Cedar Christian Crawford Dade Dent Douglas Dunklin Gasconade Henry Hickory Howell Iron Jasper Johnson Laclede Lawrence Madison Grantmaking Program 2

3 Maries McDonald Miller Mississippi New Madrid Newton Oregon Osage Ozark Pemiscot Perry Phelps Polk Reynolds Ripley Scott Shannon St. Clair St. Francois Ste. Genevieve Stoddard Stone Taney Texas Vernon Wayne Wright Brief Project Description* Please describe the project your agency would like to undertake in no more than two sentences. Character Limit: 500 Community Need* Provide a description of the community need for which your organization is requesting a grant. Why is this issue important? Measurements of Need* Provide relevant measurements or statistics in your community which indicate a reflection of the need for your proposed program. Grantmaking Program 3

4 Primary Goals* What is the primary goal of the program? What measurement tools will your organization use to determine whether your program is achieving its goals and outcomes? Character Limit: 3000 Service* Describe who will be served by this grant. How many will be served? Timeline* What is the timeline for implementing this proposed program? Please note that Coover grants must be undertaken within one year of grant presentation (April April 2019). Key Partner* Please provide the name of an organization/government entity/school district which will be a key partner in the implementation of the proposed program. Character Limit: 100 Key Partner Description* Please provide details on how the agency listed above will work with your agency on the proposed program. Character Limit: 1000 Project Financial Details Amount Requested* Please provide the amount of money requested to the Coover committee. Maximum request amount cannot exceed $20,000. Character Limit: 20 Please complete a budget for your proposed program using the Coover Budget Template spreadsheet (click here to download, and then select 'enable editing' to edit and save the document as your own). Download the template, complete it to the best of your agency's ability, and upload the completed spreadsheet. This template is in Excel format. Contact Bridget Dierks at bdierks@cfozarks.org if you have questions about the spreadsheet. Please note there are three tabs to this budget spreadsheet: 1. Instructions 2. Project budget (this is the budget for the specific project you are proposing to undertake) Grantmaking Program 4

5 3. Agency fiscal year budget (can be input in this spreadsheet or uploaded separately, see below) Coover Program Grant Budget Spreadsheet* Attach your agency's budget spreadsheet here. File Size Limit: 5 MB Agency Current FY Budget If you did not complete the agency budget tab in the Coover budget spreadsheet, please upload your agency budget in the format you prefer here (not applicable if you completed the agency fiscal year budget tab on the previous spreadsheet). File Size Limit: 5 MB Budget Narrative Justification Please provide any further details about your budget which are not on the excel spreadsheet. Examples include: rationale for a specific budget cost, details on expenses outlined in the budget spreadsheet, and any details which are not self explanatory about the budget. Character Limit: (c)3 Letter Upload 501(c)3 Confirmation Letter Upload* Please upload your organization's IRS tax exemption letter, which confirms your organization's 501(c)3 tax exempt status. If your organization is a Missouri public school district or a Missouri government entity (city or county), no upload is necessary. File Size Limit: 5 MB 990* Please upload your organization's most recently completed 990. This can include the 990-N, the 990-EX, or the 990. File Size Limit: 10 MB Clarifying details If there are any details which need further clarified with regard to your application, please provide that clarification. Character Limit: 3000 Thank you for completing the Louis L. and Julia Dorothy Coover Grantmaking Program application. Proposals will be reviewed in March and early April. Selection of the recipients of this grant will be announced on or before April 15, Grantmaking Program 5

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