Outreach Grant

Application Form

Please complete the online application below (using the submit button) and, separately, email the items listed here, labeled as indicated with the subject line “Outreach Committee Grant Funding Proposal” (with Your Organization’s Name), to the address provided below:

Attachment A: Complete copy of your budget for this project
Attachment B: Signatures from the head of the organization and contact person
Attachment C: IRS Form 990 [pdf]

Mail to:
Grace Episcopal Church
Attn: Outreach Committee
P.O. Box 1059
Kilmarnock, VA 22482

Email Attachments to: office@graceepiscopalkilmarnock.com

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Date of Request

This is a Grant Request for (check one):

An Ongoing Service / Project
A New Service / Project
Other

Describe Other

Name of Organization for Requesting Applicant

Head of Organization

First

Last

Title

Phone

Address Line 1

Address Line 2

City

State

Zip Code

Country

Contact Person in Organization

First

Last

If your application is considered, the contact person from your organization may be asked to meet with the committee to fully explain your project.

Title

Phone

Who will directly control the project?

Title of Grant Request

Amount Requested

Beginning Date of Project

Describe the project and summarize how the Grant Monies will be used:

Include with your Application

Signatures from Head of Organization and Contact Person (Attachment D)

Estimated Total Project Cost

Current Funds Available

What part of your budget for this project will be covered by this Grant?

Have you requested money for this project from any other source? If Yes, please state from whom.

How will program be supported if you do not receive this Grant?

Include with your application the most recent Annual Report

Copy of full project budget (Attachment A)
Statement of income and expenses (Attachment B)
Balance Sheet (Attachment C)

Reference 1

First

Last

List two references in our community who can tell us more about your organization and the project.

Relationship to Applicant or Organization

Phone

Reference 2

First

Last

Relationship to Applicant or Organization

Phone