APPLICATIONDEADLINE: Friday, February9, 2024, NOLATERTHAN11:59p.m.
SECTIONI –ORGANIZATIONINFORMATIONCommunity-BasedOrganizationInformation(ApplicantInformation):
FiscalSponsor(Organizationwith501(c)(3)taxstatus:
NameofOrganization:Clickheretoentertext.
ExecutiveDirectorName:Clickheretoentertext.OrganizationAddress:Clickheretoentertext.
ProjectManagerName(primarycontactforthegrant):Clickheretoentertext.ProjectManagerTitle:Clickheretoentertext.PhoneNumber:Clickheretoentertext.
EmailAddress:Clickheretoentertext.
Program/ProjectBudget:
Program/ProjectBudget:$Clickheretoentertext.
AmountofGrantFundsrequested(ineither$5,000or$10,000amount):$Clickheretoentertext.OrganizationalBudget:$Clickheretoentertext.
Fiscal-SponsorBudget(Ifapplicable):$Clickheretoentertext.
Program/Project:
Program/ProjectTitle:Clickheretoentertext.ProgramProjectSummary(50-wordlimit):Clickheretoentertext. %ofRichmondResidentsServedbyYourProposedProgram/Project?:Clickheretoentertext.WillYourProgramorProjectServeYouth(throughage21)?:Clickheretoselect“Yes”or“No”Pleaseselectone(1)categorythatBESTdescribesthetypeofprojectorprogramthatyourorganizationplanstoprovidewiththerequestedgrantfundsfromthedrop-downlist:
- 1-FY2024-25CSDMiniGrantApplication
NameofOrganization:Clickheretoentertext.
ExecutiveDirectorName:Clickheretoentertext.OrganizationAddressClickheretoentertext.
ProjectManagerName(primarycontactforthegrant):Clickheretoentertext.ProjectManagerTitle:Clickheretoentertext.EmailAddress:Clickheretoentertext.
PhoneNumber:Clickheretoentertext.
CLICKHEREandSelecttheprogramcategoryfromthedrop-down.
SECTION2–PROGRAM/PROJECTDESCRIPTION
a. Provideinformationaboutyourorganization(e.g.numberofyearsinoperation,descriptionofservicesprovidedandthepopulationserved).Clickheretoentertext. b. Describetheprogramandproposedservicesin detail.Provideinformationon the1)programdesignnadpurpose,2)typesofservices,3)location,delivery, and4)outcomestobeachieved.Clickheretoentertext. c. Providea timelineforprojectimplementationusingthetemplatebelow. Includespecifictasks/activitiesthatwillbeaccomplishedwithineachquarter.
Task/Activities Month
1 st
Term(July1,2024–December31,2024)Clickheretolist,bullet,ornumberentries. Clickheretolistcorrespondingdates.2 nd
Term(January1,2025–June30,2025)Clickheretolist,bullet,ornumberentries. Clickheretolistcorrespondingdates. d. Listthestaff membersresponsiblefortheimplementationoftheprogramorproject.Brieflydescribethestaff’s experienceworkingontheproposedprogram/projectand/orsimilarprojects.Includerésumésorprovidedescriptionsofworkexperiencewitheachcopyoftheapplication.Clickheretoentertext. e. If youplantocollaboratewithotherentities(i.e.non-profits,governmentalentities,privateentities)toimplementyourprogramorproject,pleasecompletethetablebelow.
Note: A letter of collaboration must be included as a part of your application ONLY IF yourorganization plans to partner with a government entity(ies) (e.g. city, state, county, school district,etc.).
Partner SpecificRole:Clickheretoentertext. Clickheretoentertext.Clickheretoentertext. Clickheretoentertext. - 2-FY2024-25CSDMiniGrantApplication
SECTION3–PROJECTIMPACTANDGOALS
a. Describethetargetpopulationandgeographicareathatyourorganizationplanstoservewiththegrantfundsandwhatimpacttheproposedprogramorprojectwillhaveonthetargetpopulation.Clickheretoentertext. b. Listthenumberofindividualsthatwillbeservedasaresultofyourprogramorproject.
TotalNumberofIndividualsServedbyProposedECIAFundedProgramorProject TotalNumberofRichmondResidentsServedbyProposedECIAFundedProgramorProjectClickheretoentertext. Clickheretoentertext. c. Listthemajorprogramor projectgoal(s)andhowyourorganizationwillmeasureif youreachyourdesiredgoal.Thegoalshouldbemeasurableanddata-driven.Thereshouldbeatleastone(1)expectedoutcomepermajorprogramorprojectcomponent.
MajorProgramComponent(s)
MajorProgramOutcome(s)
Indicator/Measurement
Goal EvaluationMethodClickheretoentertext. Clickheretoentertext.
Clickheretoentertext.
Clickhere.
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Clickheretoentertext.
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d. Howwillyourorganizationassessor gaugethesuccessof yourprogram/projectat itscompletion?Clickheretoentertext. e. Howdoyouplantosustaintheprogramorprojectafterthegrantfundsareexpended?Clickheretoentertext.
SECTION4–FINANCIALVIABILITY
a. Attachyourorganizationalbudgetto eachcopyof theapplication.Theorganizationalbudgetcanbesubmittedin anyformataslongasit showsrevenueandexpendituresforyourorganization’scurrentoperatingyear. b. CompletetheprogrambudgettableusingtheprovidedMSWordorMSExceltemplatetocompletethetable. - 3-FY2024-25CSDMiniGrantApplication
FY2024-25ECIAGRANTAPPLICATIONSUBMISSIONACKNOWLEDGMENT
Thispageshouldbeincludedinyourapplicationpacket.Itwillnotcounttowardyourpagelimit.
Bysubmittingthisapplicationandthesupportingapplicationmaterials,youagreethat:
● YouareanOfficerontheBoardofDirectorsoftheorganizationsubmittingthegrantapplication● YouhavethoroughlyreadandunderstandthegrantprogramguidelinesandapplicationquestionsandCityofRichmondrequirements(businesslicense,insurance,andgrantagreement)● Allquestionscontainedintheapplicationhavebeenansweredandthefollowingrequireddocumentsareincludedaspartofourapplicationpacket:☐Completedapplication(allsectionscompletedandquestionsanswered,includingresumes)☐Organizationalbudget☐Proofof501(c)(3)status(Non-ProfitStatusDeterminationletterfromtheInternalRevenueService)☐Financialstatements–mostrecent(current)auditedfinancialsorInternalRevenueServiceForm990or990-N.Reviewedorcompiledannualfinancialstatementsareallowableforfaith-basedorganizations.☐ListofBoardofDirectorsandtheiraffiliations☐Letterdescribingandauthorizingcollaborationwithagovernmentalentity(ies),ifapplicable☐Signedagreementbetweentheorganizationandthefiscalsponsor, ifapplicable● Yourorganizationwillobtaincomprehensivebackgroundchecksand/orfingerprintingofallemployeesand/orvolunteers.● Volunteersthatworkdirectlywithyouthorsuchothervulnerablepopulations.(Forapplicableorganizationsrequestingfundstosupportanexistingornewyouthprogramand/orprogramthatworkswithothervulnerablepopulations.)● Tothebestofyourknowledge,theinformationincludedaspartofthisapplicationistrueandaccurate ------------------------------------------ ClickheretoenterOrganizationName. Clickheretoenteradatefromdrop-down.
ClickheretoenterNameofBoardOfficer. ClickheretoenterTitleofBoardOfficer.
Signature–OfficerofBoard
- 4-FY2024-25CSDMiniGrantApplication
SECTION4–FINANCIALVIABILITY
a. Totalorganizationbudget(basedonprioryear’s990orauditedfinancials):ClickheretoenterOrganizationalBudget. b. Includeyourorganizationalbudgettoeachcopyoftheapplication c. Completethebudgettemplatebelow. If needed,addrowsandprovideasmuchdetailaspossibleintherevenueandexpendituresections.● Revenuesection:Listall of therevenuesourcesthatwillfundyourproposedprogram(e.g.grants,programfees,in-kinddonations)andstatethosesourcesarependingand/orapproved.Includeyourorganization’sECIArequest.● Expenditures:List,withasmuchdetailaspossible,theexpenditurecategories(e.g.salaries,benefits,programsupplies)● Therevenuetotalandtheexpendituretotalin the“ECIARequest”columnshouldmatch.Thesameistrueforthe“ProjectBudget”column.For example, if your organization is requesting a total of $10,000 fromthe ECIAgrantprogram, that amount should be listed in the “Revenue” sectionof thebudget table. Youwould then need to complete the “Expenditure” section of thebudget table, makingsurethat the total amount of the expenditures is also equal to $10,000 (the total amount oftherevenuerequested).● Usethe“BudgetNarrative”sectiontojustifyandexplaintheexpendituresoutlinedinyourprogrambudgettable.
ProgramBudgetTable
CSDMiniGrantApplication–BudgetTable
REVENUECategory(ListFundingSources)
CSDMiniGrantRequest
ProjectBudget RevenueStatus(Approved/Pending)
RevenueTotal $ $EXPENDITURESCategory CSDMiniGrantRequest ProjectBudget BudgetNarrative(ifapplicable)
ExpenditureTotal $ $