United Methodist Community Ministries Grant Application Checklist Applications for 2017 funding must be returned by October 3, 2016

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United Methodist Community Ministries Grant Application Checklist Applications for 2017 funding must be returned by October 3, 2016 Ministry Partnership Name YOUR GRANT REQUEST IS NOT COMPLETE WITHOUT ALL OF THE FOLLOWING: Grant Request form completed in its entirety Financial Reporting submitted as an Attachment: One complete spreadsheet/report (2015-2017 required information) OR Three separate spreadsheets/reports including 2015 Ministry Actual Income and Expenses 2016 Year to Date Ministry Actual Income and Expenses 2017 Ministry Income and Expenses Proposed Budget List of partners Signature page with all signatures Roster/Attendance Sheet for board/leadership team Two recommendations from pastors Two impact stories One hard copy of all required documents delivered to the UMCM office by October 3, 3, 2016, 4:00 pm - no staples This Checklist completed

United Methodist Community Ministries Ministry Partnership Grant Application For funding year 2017 Who can apply: The UMCM Outreach Grant program exists to help local UMC ministry partnerships launch new outreach ministries in their community, or expand existing ministries which have not been previously funded by UMCM (since 2013). "Ministry Partnership" is defined as a group of churches doing ministry together. Grants will be given to ministries whose mission and activities are consistent with UMC social principles, and where UM Churches have an active and significant role. Ministries are eligible to apply for 3 consecutive years. If funding was received for only one or two of the three year period, the ministry is not eligible to apply later for the 2nd/3rd year(s). Funding preference will be given to new(er) ministries. Eligible ministries are those which serve the greater community where the churches are located. Instructions: Complete one grant application for each ministry partnership for which you are requesting funds. Narrative (non-budget) portion of your proposal should be limited to six pages, single spaced, font size 12. Answer every question. For new ministries, answers and stories should come from the visioning and discernment process which led you to start this ministry. Note that Ministry means the specific community outreach ministry for which you are requesting funding. A site visit is required prior to approval. An interim report is required during the grant funding year. Your completed grant application - one hard copy - must be received at the UMCM office by Monday, October 3, 2016, 4:00 pm. NOTE OUR NEW ADDRESS: United Methodist Community Ministries, 2545 Farmers Dr., Suite 350 Columbus, Ohio 43235. A copy of the grant and financial reporting forms are available at www.umcommin.org. Name of Ministry Partnership: Payee - if different than the Ministry Partnership name: Mailing Address: Phone: Website: Contact Person & Title: Best phone: E-mail: Amount of Funds requested (Maximum $4,000): Total projected cost for this Ministry in 2017: (UMCM Grant funding will be a maximum of 2/3 of the Ministry's budget) Did this Ministry receive a UMCM Grant in: 2013 2014 2015 2016

A. Ministry Partnership Specifics: 1) This is: An existing Partnership, year started A new Partnership 2) List each unique outreach ministry provided by this Partnership and answer the following: a) What are the main activities of this Ministry? b) What are the location and hours of operation for this Ministry? c) Current number served per month for a three year period : 2014 2015 2016 3) What is the overall vision and mission of the Ministry Partnership? 4) Describe who is this Ministry designed to serve, i.e. working poor, homeless, elderly, etc.? 5) How is this Ministry reflecting the diversity of the area served and intentionally opening itself to persons of diverse backgrounds? 6) List the churches, faith-based and secular organizations who serve as significant partners, and the nature of their role and participation. 7) How is this Ministry Partnership evolving or growing? 8) Describe two goals or planned improvements for this Ministry Partnership for 2016-2017? 9) List any workshops or training events persons from this Ministry Partnership have attended in the past year, and the number of board members or volunteers who attended. What changes have been made because of the training? B. Organizational Structure: 1) List the board or leadership team members, titles, and church or organization they represent. Include attendance record of board members at regular meetings. 2) How many persons receive a salary or wages for their work in this Ministry? 3) Is this a 501(c)(3) organization? Yes No If No, do you plan to apply for 501(c)(3) status in the next 12 mos? Yes No 4) Do you have liability insurance to cover the activities of this Ministry? Yes No 5) Does this Ministry have its own bank account? Yes No If No, who is the Partnership's fiscal agent?

C. Faith Connection 1) What specific activities serve to impact the spiritual life of the congregations involved, and to encourage their involvement in the Ministry Partnership? 2) What specific activities serve to minister to the spiritual lives of the recipients? 3) How are you building relationships with the people served by this Ministry? 4) Include two UMC pastors' recommendations in which they share how this Ministry Partnership is impacting their congregation. 5) Impact Stories: Even new Ministries have stories, i.e. how did you identify the need for this Ministry? Include stories here and email a Word file to gshimrock@wocumc.org. a) Share a story of how a volunteer has been impacted by this Ministry Partnership. b) Share a story of how a recipient has been impacted by this Ministry Partnership. D. Financial Information for the Ministry Partnership This section pertains only to the Ministry Partnership referenced in this grant. Do not provide information for any church's or partner's general budget. Do not provide check or deposit registers, or full general ledger activity reports. Information must be summarized as requested clearly showing totals for income, expenses, and net income. In-Kind donations should be reported as both income and expense as a separate line items. In-Kind donations and expenses do not count for the 2/3 of budget grant funding limit. 1) If you use Excel or another spreadsheet: One report option - refer to the sample spreadsheet attached and also available on the UMCM website as an Excel file you may customize to your Ministry. 2) If you use an accounting system: Refer to the sample spreadsheet attached, and generate system reports which produce comparable information. This will likely result in separate reports for each year (three total reports). 3) Essential elements of the financial reporting: a) A year-end 2015 income and expense report for the Ministry, showing actual income and expenses compared with the 2015 budget. b) A current year-to-date (through August 2016) income and expense report for this Ministry, showing actual income and expenses compared with the 2016 budget. c) A projected budget for 2017 for this Ministry showing both income and expenses. Include 2017 projected capital expenses for items which primarily benefit your Ministry (not the church in general). UMCM grants are not intended to pay for transportation related costs. In your budget show how the partner congregations contribute financially to the Ministry. UMCM will provide no more than 2/3 of the Ministry budget as stated on pg 1, excluding In-Kind donations and expenses.

4) Explain your plan and time frame for becoming financially self-sufficient (taking into account the UMCM grant 3 year funding limit). 5) How and where are you seeking additional funding for 2016 and beyond, in-kind contributions, etc? What if any funding have you applied for/received from other United Methodist sources? E. Required Signatures: I have read the grant proposal and I fully understand and support this outreach Ministry Partnership. I understand that application for a Community Ministries grant is not a guarantee of funding, and that grants are limited to three consecutive years. Director: UMC Partner Pastor: Board/Leadership Team Chair: Grant Writer: Date: v. 6/2016