Grantwriting Worksheet Please enable JavaScript in your browser to complete this form.Organization and Tax-Exempt StatusOrganization Name *Also Known As/Doing Business As (D/B/A):Tax Exempt Status Nonprofit 501(c)(3)Nonprofit - But, not a 501(c)(3)For Profit OrganizationFederal Tax Identification Number (EIN)Tax Exempt Date DateTimeWill this Organization use a Fiscal Agent or Sponsor YesNoI am not sureOrganization Contact InformationOrganization AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeMailing Address (if different than above)Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeOrganization PhoneOrganization EmailWebsitePrimary Contact Name *FirstLastPrimary Contact Title *Primary Contact Person PhonePrimary Contact EmailEmailConfirm EmailABOUT YOUR PROGRAM/PROJECTRequest SummaryProject Title *Requested Amount * $500- $5,000$5,001 - $10,000$10,001 - $20,000$20,001 - $35,000$35,001 - $50,000$50,001 - $75,000$75,000 - $100,000Over $100,000I am not sure yetSPECIFICALLY, what will you use the funds for: *Type of Support (check all that apply) *Seed Money - New ProjectProgram - Direct ServicesOperational - Rent, Utilities, Salaries, etc.ConstructionCapacity Building - Expanding ServicesConferences, training, workshopsStudent ScholarshipsTechnical Assistance- Nonprofit DevelopmentDemographicsGeographical Area Served (List specific cities, counties, or states) *Population Served (i.e. veterans, homeless, at-risk youth, seniors, prisoner re-entry, those who are suicidal or depressed, etc.)Age Group ServedGender ServedRequest DetailsDescribe The Program To Be Funded. (Do not describe "why" it's needed. Instead, describe "what" you do each day)Program Status This is a new programThis is an existing programNew Program: When will this program begin?Existing Program: When did this program start?How many people do you anticipate serving/helping in the next 12 months?How many people did you serve/help in the last 12 months?What Are Your Program Goals? (i.e. At the end of the program, what do you hope to accomplish?)List Three (3) Actions Your Organization Will Take to Achieve Your Goals?Who Do You Partner With? (State the Organization Name, City, and How you Collaborate)Program BudgetProject Budget TotalList Your Major Sources of Income (i.e. where will you get money from to run this program)?List Your Major Expenses (i.e. what will you spend money on to run this program)?ABOUT YOUR ORGANIZATIONOrganization Mission:Organization History/Background:Organization Board: (List each Board Member and their title).Organization Staff: Do you have anyone on payroll, if so, please list name, title, and annual salaryLAST YEAR: Income and Expenses (Organization) INCOME: How much did you receive in Grants and Contributions?INCOME: How much did you receive for service fees? (i.e. rent, daily care, etc.)INCOME: What other income did you receive last year? (i.e. board, fundraising)INCOME: What was your TOTAL INCOME last year?EXPENSES: How much did you spend on program services?EXPENSES: How much did you spend on administration (business fees, consultants, accountants, insurance, marketing, postage, etc.)EXPENSES: How much did you spend on fundraising?EXPENSES: What did you spend on "other" expenses?EXPENSES: What were your TOTAL EXPENSES last year?THIS YEAR: Income and Expenses (Organization)INCOME: How much have you received in Grants and Contributions? INCOME: How much have you receive for service fees? (i.e. rent, daily care, etc.) INCOME: What "other" revenue have you received? (i.e. board, fundraising)INCOME: What is your total income as of today?EXPENSES: How much have you spent on program services? EXPENSES: How much have you spent on administration (business fees, consultants, accountants, insurance, marketing, postage, etc.) EXPENSES: How much have you spent on fundraising?EXPENSES: What have you spent on "other" expenses?EXPENSES: What is the total organization expenses as of today?Thank you!MessageSubmit