Community Leadership Partners and Beach Fund
Grant Programs Application

Proposal Contact Information
Organization Name:________________________________ EIN: ____________________________
Address: ________________________________________________________________________
City, State, Zip Code: ______________________________________________________________
Contact Person: ___________________________________________________________________
Title: ___________________________________________________________________________
Phone Number: __________________________________ E-mail Address: ___________________

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Basic Project Information
This application is being submitted for: (if for both programs, please check both)

Total amount of grant request from the Hampton Roads Community Foundation: $_______________________________

Total program budget: _________________________Funds will be used during the time period: __________________
The executive director or chair of the organization’s board of directors must sign this application.

_________________________________ ________________________________
Signature                                                               Title

_________________________________ ________________________________
Print Name                                                           Date

Narrative

1. In the space below please provide your organization’s mission statement and a brief history of your organization including year of incorporation.

2. In the space below please describe the program for which you are seeking funding. If possible, please give a brief description of the evidence that the program is effective with the population.

3. In the space below please detail the total number served (or to be served) and client demographic of the program for which you are seeking funding. Please include number served (or to be served) in each city where the program operates (or will operate).

4. In the space below please describe all program outcomes to be tracked and how often and by what method the data will be collected.

5. In the space below please include the outcomes data for all years in which your program has been operating.

6. Please describe how the requested funds will be used.

7. Does your organization have a strategic plan? ______Yes _______No

If yes, please attach a copy to this application

8. Beach Fund Applicants (Optional): If you are able to provide a one-time, one-day volunteer opportunity for 10 to 12 volunteers, please briefly describe the opportunity. Note: A volunteer opportunity is not required.

Please provide the following documents as attachments to the application:

• A detailed, itemized program budget that includes revenues and expenses.
• A list of contributors to this program
• A list of other pending grant requests, the amount requested and an estimated decision date.
• Board of directors list with mailing addresses and if available, the primary professional and/or civic affiliations of each member
• Most recent audited financial statements or IRS Form 990 (If your organization does not have either, please enclose your most recent Profit/Loss Statement and Expense/Revenue Balance Sheet)
• Your organization’s current and previous year’s operating budget, including revenues and expenses