1 Submit your completed application package to [email protected] by 11:59 pm on Friday, February 25, 2022.
Questions? E-mail [email protected], call 510-620-6563, or visit www.richmondloveyourblock.org.
FY2021-2023 Love Your Block Mini-Grant Application
PLEASE TYPE DIGITALLY—HANDWRITTEN APPLICATIONS WILL NOT BE CONSIDERED.
SECTION 1: APPLICANT INFORMATION
Please select your applicant type:
☐ Organization utilizing a non-profit 501(c)3 fiscal sponsor – must complete Sections 1, 2, 3, 4, 5, 6 ☐ Non-profit organization with 501(c)3 status – must complete Sections 1, 3, 4, 5, 6 Organization Name: Organization Name
Organization Address: Address, City, State, Zip
Executive Director First Name: First Name Executive Director Last Name: Last Name Executive Director Phone: Phone Executive Director E-mail: E-mail Project Manager First Name: First Name Project Manager Last Name: Last Name Project Manager Phone: Phone Project Manager E-mail: E-mail SECTION 2: FISCAL SPONSOR INFORMATION
LEAVE THIS SECTION BLANK IF YOUR APPLICANT TYPE IS “NON-PROFIT ORGANIZATION WITH 501(C)3 STATUS”.
Note: Please review the Mini-Grant Information prior to beginning your application to fully understand the documents your fiscal sponsor will need to provide and documentation deadlines your fiscal sponsor will need to follow.
Fiscal Sponsor Organization Name: Fiscal Sponsor Organization Name Executive Director First Name: First Name Executive Director Last Name: Last Name Organization Address: Address, City, State, Zip
Phone: Phone E-mail: E-mail
SECTION 3: PROJECT DESCRIPTION
Project Title: Project Title
Project Summary (100 words or less):
Enter text
Project Budget: Project Budget
Grant Amount Requested (up to $10,000): Amount Requested Project Start Date (must be July 1, 2022 or later): Click here to select a date.
Project End Date (must be April 30, 2023 or earlier): Click here to select a date.
2 Submit your completed application package to [email protected] by 11:59 pm on Friday, February 25, 2022.
Questions? E-mail [email protected], call 510-620-6563, or visit www.richmondloveyourblock.org.
Project Site Address: Address, City
Is the Project Site…
• A City of Richmond Park or Trail (i.e. Richmond Greenway)? Select Yes or No • Accessible by the public? Select Yes or No
• Within the boundaries of the City of Richmond? Select Yes or No • Encroaching on property of a public agency other than City of Richmond (i.e. CalTrans, BART)? Select Yes or No
If “Yes”, you must submit proof of a pre-existing agreement with the agency or your application will be disqualified.
• On private property? Select Yes or No
If “Yes”, you must submit a signed Letter of Permission from the property owner authorizing the project.
Project Site Photos: Insert one (1) photo below showing the current condition of your project site. If you are having technical difficulty with this function, you may attach it separately in your submission.
3 Submit your completed application package to [email protected] by 11:59 pm on Friday, February 25, 2022.
Questions? E-mail [email protected], call 510-620-6563, or visit www.richmondloveyourblock.org.
Describe your Love Your Block Mini-Grant project proposal. Be sure to include the number of community events you will host and what those events will entail.
Enter text
What is the overall goal of your Love Your Block Mini-Grant project? Enter text
What metrics/data will you gather to show the impact of your project? List at least 3.
Enter text
4 Submit your completed application package to [email protected] by 11:59 pm on Friday, February 25, 2022.
Questions? E-mail [email protected], call 510-620-6563, or visit www.richmondloveyourblock.org.
SECTION 4: VOLUNTEER & NEIGHBORHOOD ENGAGEMENT
List any individuals or entities you will be partnering with for this mini-grant and provide their role.
Enter text
How many volunteers will be recruited for your project? # of volunteers What will be the role of volunteers in your project?
Enter text
How will you involve resident volunteers, community members, organizations, and/or businesses outside of your current network?
Enter text
What community outreach methods will you use to recruit volunteers for and publicize your project? Enter text
What measures will you take to prevent the spread of COVID-19 during the course of your project? Enter text
5 Submit your completed application package to [email protected] by 11:59 pm on Friday, February 25, 2022.
Questions? E-mail [email protected], call 510-620-6563, or visit www.richmondloveyourblock.org.
SECTION 5: BUDGET
Complete the budget form below. Be as detailed as possible. Thoroughly review the Mini-Grant Guidelines for information on eligible and ineligible costs, and contact Love Your Block staff if you have any questions.
Ineligible expenses will result in disqualification.
Item Description/Purpose Cost Quantity Total Cost
Item 1 Item Description $0.00
Item 2 Item Description $0.00
Item 3 Item Description $0.00
Item 4 Item Description $0.00
Item 5 Item Description $0.00
Item 6 Item Description $0.00
Item 7 Item Description $0.00
Item 8 Item Description $0.00
Item 9 Item Description $0.00
Item 10 Item Description $0.00
Item 11 Item Description $0.00
Item 12 Item Description $0.00
Item 13 Item Description $0.00
Item 14 Item Description $0.00
Item 15 Item Description $0.00
Total Amount Requested: $0.00
6 Submit your completed application package to [email protected] by 11:59 pm on Friday, February 25, 2022.
Questions? E-mail [email protected], call 510-620-6563, or visit www.richmondloveyourblock.org.
SECTION 6: ACKNOWLEDGMENT
By submitting this application, the applicant acknowledges the following:
• Applicant has thoroughly read and understands the Love Your Block Mini-Grant Guidelines, Love Your Block Mini-Grant application questions, and the City of Richmond and Community Services Department requirements.
• All questions contained in the application have been answered and the following required documents are included as part of the application packet (check all boxes):
☐ Completed application (all sections completed and questions answered) in readable PDF or Word format (scanned files are not accepted)
☐ Proof of 501(c)(3) status (Non-Profit Status Determination letter from the IRS) ☐ City of Richmond W-9 form for the 501(c)3 organization ☐ Vendor Supplemental Questionnaire
• The following documents are included in the application packet as needed (check applicable boxes):
☐ Signed Letter of Permission from property owner, if proposal takes place on private property ☐ Signed agreement with a public agency, if proposal encroaches on non-City public property ☐ Signed agreement between the organization and the fiscal sponsor, if applicable • Applicant’s organization will obtain comprehensive background checks and/or finger printing of all employees and/or volunteers that work directly with youth or such other vulnerable populations. (For applicable organizations requesting funds to support an existing or new youth program and/or program that works with other vulnerable populations); and
• The information included as part of this application is true and accurate.
Applicant Name Organization Name
Applicant Name (Type) Organization Name
Click to enter a date
Date