Catholic Diocese of Richmond - Office of Catholic Schools Capital Needs Matching Grant Fund Grant Application

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Catholic Diocese of Richmond - Office of Catholic Schools Capital Needs Matching Grant Fund Grant Application Instructions: Please complete all portions of the application, submit the required supporting documents, and obtain the required signatures. You may refer to the Program Highlights section of the Program Guidelines for due dates and response times. Applications may be submitted either electronically or by hardcopy. Electronic submissions may be emailed to Ray Honeycutt, Interim Superintendent of Catholic schools rhoneycutt@richmonddiocese.org and Natasha Feher, Administrative Assistant/Data Specialist nfeher@richmonddiocese.org. Please carbon copy (cc) the Chair of the School Board and the Pastor for parish owned school buildings. Hardcopy submissions may be sent to: Catholic Diocese of Richmond, ATTN: Ray Honeycutt, Interim Superintendent of Catholic Schools, 7800 Carousel Lane, Richmond, VA 23294. School Name: Address: Phone Number: E-mail Address: Principal s Name: Primary Contact Name: Enrollment K-Grade: Pre-K Enrollment: Brief Description of Project: Total Project Amount: Amount of Grant Requested (no more than 50%): Request exemption from 50% maximum limit: Source of Local Funding and Amount: Status of Project with the Diocesan Building and Renovation Commission (BARC) (circle one): Choose an item. Exempt from BARC, explain: I certify that: 1. Any grant awarded to this School will be used only for the project outlined in this application and any unused funds will be returned to the Catholic Diocese of Richmond, Capital Needs Matching Grant Fund. 2. I will submit a report to the Catholic Diocese of Richmond within one month of the completion of the project. If the project extends beyond one year, I will submit a report annually, and then upon completion of the project. Signatures: Principal Chair, Advisory School Board Pastor, if necessary

Catholic Diocese of Richmond - Office of Catholic Schools Capital Needs Matching Grant Fund Grant Application Age of Building: Detailed Description of Project Age of component subject of grant: Expected date of completion: Click here to enter a date. Narrative Description and Background of Project: Describe how project will enhance the educational environment for students: Describe how the cost of the project was developed, i.e., architect, contractor, bid, etc. Detailed cost of project (attach a separate sheet if necessary): Provide additional information on the source and timing of local funding: If the school has building needs identified in the FCA report and those needs are not addressed by the grant request, please provide an explanation regarding how the school plans to address all needs outlined in the FCA report. If this grant is not approved, what steps will be taken to address this need? For questions, please call Ray Honeycutt, Interim Superintendent, at (804) 622-5118. Attachments: Most recent school annual financial report and budget Correspondence with BARC Drawings, bids, renderings, etc. CT1545 Proposal Comparison Sheet Checklist

CATHOLIC DIOCESE OF RICHMOND FORM CT1545 : (Revised 07-01-2014) Parish Name: Location # Project Title: Est. Cost $ Pastor: Contact Person (If other than the pastor): Telephone Number: Email Address: Building Type (church, school, rectory, social hall or other): Project Type (new construction, addition, renovation or maintenance): Current Funds Available for Project: Is this project being funded by a Capital Campaign? YES NO If yes, is an exemption from the Cathedraticum Tax being requested? YES NO On a separate sheet, please provide a description of the project. Include the following: A discussion of the needs to be addressed by the project. The intended capacity (for example, number of seats or classrooms). The vision of how the project might relate to the other parish facilities. A discussion of the extent of parish involvement to date (communities and at-large). A description of professional consultation (architects or engineers) to date. A description of the project s financial plan, i.e., sources and uses of funds. Other information that would be helpful for understanding the project. Name and Title (Please Print) Signature PLEASE SEND TO REV. ROBERT J COLE, BARC COMMITTEE CHAIRMAN AT frrob@sjavb.org OR 1968 SANDBRIDGE ROAD, VIRGINIA BEACH, VA 23456 Thank you for this information. A diocesan representative will contact you to assist with the subsequent steps in this process.

PROPOSAL COMPARISON WORKSHEET Proposal 1 Proposal 2 *Proposal 3 Company Name Price Payment Terms Description Specifications Any Comments Options/ Alternates Description of Warranty

Capital Needs Grant Matching Fund Program Checklist of Required Documents: Signed Application CT1545 Form (For all work over $25,000; copy to Fr. Rob Cole: frrob@sjavb.org) Scope of Work Proposal #1 Proposal #2 (Proposals need to be within 10% of one another or a 3 rd proposal will be required) Proposal #3, if needed Proposal Comparison Sheet BARC documentation, if applicable Specific Evidence of Donor Match Financial Information Miscellaneous (i.e., Drawings, pictures, etc.) Email to: Copy to: Ray Honeycutt: rhoneycutt@richmonddiocese.org Natasha Feher: nfeher@richmonddiocese.org