Application checklist and sign-off 2016-17
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- MID-ATLANTIC MINISTRY FUND APPLICATION COVER PAGE 2016-17
- MUST be a Sister/Associate/Companion of Mercy from the Mid-Atlantic Community
- GRANT PROPOSAL Organization:__________________________________________________ Project:_______________________________________________________
- Financial Summary Budget Format Program/Project Title: _________________________________________________ PROJECTED PROGRAM/PROJECT BUDGET
- __________________
- 4. Total Projected Expenses ____________________
- Organization: _________________________________________________________
| APPLICATION CHECKLIST AND SIGN-OFF 2016-17
ORGANIZATION: ___________________________________________ PROGRAM FOR WHICH GRANT IS SOUGHT: ________________________ AMOUNT REQUESTED:____________________________________________ SISTER/ASSOCIATE/COMPANION REQUESTING GRANT:______________________ The check-off below is designed to insure that all relevant materials are included in your grant packet. Please check that each one is present or indicate why an item might not apply to your program/organization. The following have been included in this packet: (check all those that apply) Application Cover page ____ Grant Proposal ______ Executive Summary ____ Board of Directors ______ Program Budget ____ The following information, requested above, is not applicable to our organization: (Please note-though not required to be submitted with your application, organizational documents such as audited financial statement, organizational budget, etc. must be available upon request by the Committee during the review period). Person submitting grant: _____________________________________ (MUST be a Sister of Mercy/Associate/Companion from the Mid-Atlantic Community) Email address:_____________________________________ If proposal is approved, check should be made payable to: Name: __________________________________________________ Address: ___________________________________________________ ____________________________________________________ MID-ATLANTIC MINISTRY FUND APPLICATION COVER PAGE 2016-17 Organization submitting proposal: _______________________________ Date: ___________ Organization’s Address: ____________________________________________________ ____________________________________________________ Contact info: Phone: ___________________________ Fax: _______________________ e-mail: _____________________________ website: _____________________ Organization Executive Director: ______________________________________ Person Submitting Proposal: _____________________________________ (MUST be a Sister/Associate/Companion of Mercy from the Mid-Atlantic Community) Indicate your relationship to project/program: ____ full time employee ___ part time employee ____ Volunteer ____ Board Member Summary of Project: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Projected Start Date: _________________ Completion Date: ________________ Total Cost of Project:: _____________ % of total Requested from Ministry Fund: __________ Amount raised through other sources: Public funds: ______________ Donations: __________ Rec’d a previous grant from the Ministry Fund: ___yes __no. Year:_____ Amount: _________ Other kinds of financial support received from the Mid-Atlantic Community in the last year (i.e. Sister’s salaries, free space usage, etc.):____________________________________________ Do you anticipate any changes in this financial support from the Mid-Atlantic Community over the next year? __________________________________________________________________ Organization Budget for last fiscal year: _______________________ Type of request & amount: Planning (up to $10,000) ______ Ministry: (up to $15,000) _______ GRANT PROPOSAL Organization:__________________________________________________ Project:_______________________________________________________ Amount Requested:_____________________________________________ Submitted by: __________________________________________________ Executive Summary: In one page please highlight the significant elements of your proposal and what makes your organization the one who can effectively accomplish the project. Proposal Narrative In a maximum of 4 pages, answer the following: Brief history of your organization, its mission, present-day services Description of project/program for which your organization seeks funding Description of population being served (number, demographics, etc.)\ Number of full and part-time staff for the project/program and brief indication of their qualifications Specific goals, objectives of the project/program and how you will measure success/effectiveness (evaluation procedures) Decision-making processes used in the project/program, with attention to how it involves those served in developing and evaluating services Relationship of the project/program to the Direction Statement and Critical Concerns of the Sisters of Mercy of the Americas and Mid-Atlantic Community Specific information about how the project/program will be financed if it is on-going Budget for project/program, using budget page provided with attachments for clarifications and other sources of funding as needed Financial Summary Budget Format Program/Project Title: _________________________________________________ PROJECTED PROGRAM/PROJECT BUDGET 1. Operating Income Sources Amount A. Mid-Atlantic Grant Request: _________________ B. Other Income/Funding Fees: ________________ Government/Public Funding: ________________ Other (specify sources and amounts) ________________ In-kind contributions (explain in clarifications) _________________ Total Projected Income __________________ 2. Operating Expenses (include those that apply) A. Salaries: ________________ B. Benefits __________________ C. Rent ___________________ D. Utilities & Heat ___________________ E. Telephone/postage ___________________ F. Training: ___________________ G. Office Supplies ___________________ 3. Other Program Expenses (please specify) Equipment purchases __________________ Transportation costs __________________ Marketing/advertising __________________ Other (please specify) __________________ Administrative/Overhead __________________ 4. Total Projected Expenses ____________________ J. Projected Program Profit (Deficit) ____________________ K. Budget clarifications: explain here or on an attached page any budget explanations you wish to include Organization: _________________________________________________________ 
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