Fill and Sign the 2010 Tuscreia Lease Rental Agreementdoc Form

Quilter’s Guild of Dallas, Inc. 305 Spring Creek Village, Box 521 Dallas, TX 75248-5744 http://www.quiltersguildofdallas.org QGD Helena Hibbs Grant Application Cover Sheet Tab to each section to complete forms. Please mail with your proposal and attachments. Grant Award Year – 2012 Grant Amount Requested _________ Contact/Coordinator Name ________________________________________________________ Organization/Group Name ________________________________________________________ Mailing Address ________________________________________________________________ City __________________________________ State ________ Zip (9 digit) ________________ Phone _____________________________ Email ______________________________________ Project Title ____________________________________________________________________ Project Start Date ____________________ Project Completion Date ________________ OR □ Check if Project is Ongoing Project Website _________________________________________________________________ Local Newspaper _______________________________________________________________ Address _______________________________________________________________________ Contact Person ______________________________ Email ______________________________ For Office Use Only Award Amount _________________ Date Recipient Notification Mailed ____________________ Receipt of Signed Grant Award Contract _______________________________________________ Interim Report Due _______________________ Date Received ____________________________ Final Report Due _________________________ Date Received ____________________________ Check # ______________ Mailed _____________ Amount _____________________ Check # ______________ Mailed _____________ Amount _____________________ Rev. 062911 Page 1 of 8 Quilter’s Guild of Dallas, Inc. 305 Spring Creek Village, Box 521 Dallas, TX 75248-5744 http://www.quiltersguildofdallas.org QGD Helena Hibbs Grant Application Part I – Financial Status Designation Name and Address of Individual or Group Applying for Grant Name _________________________________________________________________________ Address _______________________________________________________________________ City __________________________________ State ___________ Zip (9 digit) _____________ Note: You do not have to be tax-exempt to apply for a grant. However, we are required to report to the IRS, the amount of grant monies awarded. Please check one of the following designations and fill in the appropriate tax information: _____ Organization with recognized Internal Revenue Service 501(c)(3) tax exempt status. A Copy of your IRS determination letter must be included with this application. Tax ID# ____________________________________ _____ Organization/individual without tax-exempt status, but represented by a fiscal sponsor with recognized Internal Revenue Service 501(c)(3) tax exempt status. A copy of your fiscal agent’s IRS determination letter must be included with this application. Name of fiscal agent: ______________________________________________________ Address of fiscal agent: ____________________________________________________ Tax ID# ____________________________________ _____ Organization/individual without 501(c)(3) status whose activities, programs and projects conform to IRS definition of charitable, educational, or scientific activities. Tax ID or Social Security Number ______________ (SS# will be required with contract) _____ Organization/individual without any tax exempt status as noted above. Social Security Number will be required with contract for tax reporting purposes ___________________ As a duly authorized representative of the above named organization/individual, I confirm that the above information is true and accurate. If you are using a fiscal agent, this form must be signed by that organization/s duly authorized representative. Signature_________________________________ Print Name ___________________________ Title ____________________________________ Date _________________________________ Rev. 062911 Page 2 of 8 Quilter’s Guild of Dallas, Inc. 305 Spring Creek Village, Box 521 Dallas, TX 75248-5744 http://www.quiltersguildofdallas.org Part II – Grant Award Contract Compliance: I accept and will comply with the following QGD Grant Award Requirements: • All information represented in this application is true and accurate. • A final detailed report as to how grant monies were spent will be submitted no later than due date specified in Grant Award Contract. • I understand that 50% of the award will be made upon QGD’s receipt of the signed Grant Award Contract. (This contract is mailed to Grant Recipient upon notification of award.) The balance of the award is contingent upon the recipient’s submission of an interim progress report as specified in the Grant Award Contract. • Grant Recipient shall acknowledge the Quilter’s Guild of Dallas, Inc. as being a funding sponsor of the project in all lectures, documentation, publicity, press releases, media coverage and printed material associated with this project. The following acknowledgment must be used: “The (organization/project) is funded in part by the Quilter’s Guild of Dallas, Helena Hibbs Endowment Fund.” Supporting evidence of these acknowledgements must be included in the final report. • If the project is not initiated and/or completed as proposed, notification will be mailed to the Quilter’s Guild of Dallas, Inc. via certified mail and all funds awarded will be returned immediately. • If a Grant Recipient makes money from a commercial product, which the grant has in any way underwritten, then said grant monies must be repaid to the Quilter’s Guild of Dallas Endowment Project Fund. In such a case, an agreement would be reached by both parties prior to the awarding of the grant and would be contingent on actual profits realized from the commercial venture. • To encourage objectivity in the selection process, members of the Endowment Committee prefer not to be contacted personally by Grant Applicants. Lobbying of the Endowment Committee by or on behalf of a Grant Application will result in the disqualification of the proposal in question. Grant Funds are distributed to an individual or institution/organization without regard to race, color, creed, national origin, sex or handicap. Current members of the QGD Endowment Committee are not eligible to apply. Applicant Signature ____________________________________ Date ___________________ SUBSCRIBED AND SWORN TO before me on this ______ day of ______________,_______ ___________________________________________________ Notary Public, State of ______________________ _________________________________________ Printed Name of Notary My Commission Expires: __________________________ Rev. 062911 Page 3 of 8 Quilter’s Guild of Dallas, Inc. 305 Spring Creek Village, Box 521 Dallas, TX 75248-5744 http://www.quiltersguildofdallas.org Part III – Proposal Narrative Insert your Responses OR Using no more than five (5) pages single spaced, one inch margins all around and no smaller than 10 point Times New Roman, provide a written narrative, including answers to the following questions: (If additional space is needed, please add as an Attachment – “Proposal Narrative Continued”) 1. What is your individual or organization’s mission? What is your individual/organizational history as a quilt maker, quilt historian, quilt related researcher, or quilt-related community service group? 2. What is the purpose of the project? Why should it be undertaken? Who will benefit? Rev. 062911 Page 4 of 8 Quilter’s Guild of Dallas, Inc. 305 Spring Creek Village, Box 521 Dallas, TX 75248-5744 http://www.quiltersguildofdallas.org 3. What is the methodology for this project? What are the activities that will be undertaken? What is the length of the project? How will the project conclude? 4. What are the goals for the project: How will you know the goals have been or are being achieved? 5. List all other entities you are seeking funding from, the amounts you are seeking and their contact information. Rev. 062911 Page 5 of 8 Quilter’s Guild of Dallas, Inc. 305 Spring Creek Village, Box 521 Dallas, TX 75248-5744 http://www.quiltersguildofdallas.org 6. Who is the project leader? What is their experience? What qualifies them to lead this project? (As an attachment, include the resumes of the Project Leader/s, and all other individuals working on the project in a leadership role. Include their name, contact information, title, description of their responsibilities and duties with this project as well as work related qualifications.) 7. If this project is on-going, how will you continue to fund your efforts? 8. Identify any similar projects being done by others. What makes your project different and unique? 9. List all individuals or groups you are collaborating with on this project. Include their contact information and a description of their involvement in your project. Please include a Letter of Commitment from such individuals/groups. Rev. 062911 Page 6 of 8 Quilter’s Guild of Dallas, Inc. 305 Spring Creek Village, Box 521 Dallas, TX 75248-5744 http://www.quiltersguildofdallas.org Part IV – Budget Please complete the following budget for your project. Do not enter anything in the shaded areas. Please note that we do not support expenses that would be considered general operating costs. ANTICIPATED REVENUE Column A Column B A+B AMOUNT QGD REQUEST TOTAL My/Our own Contribution Cash Donations from Individuals Grant Requests In-Kind Donations Events and/or Admissions Product Sales Other Sources (please identify) TOTAL ANTICIPATED REVENUE ANTICIPATED EXPENSES AMOUNT USE OF QGD FUNDS A+B TOTAL Salaries Employee Related Expenses Contract Labor (individuals paid for their unique expertise for this project only – Describe) Consumable project supplies (i.e., material, thread) List items to be purchased Office Supplies Travel and Mileage Reimbursement Postage and Delivery Printing Telephone, FAX, Internet Access Rent Utilities Maintenance Insurance Marketing Expense/s Other (Please identify) TOTAL ANTICIPATED EXPENSES NET PROFIT OR (LOSS) Use a separate page to describe expensed categories and all items identified as “OTHER”. Please label it: Part IV – Budget Explanation Rev. 062911 Page 7 of 8 Quilter’s Guild of Dallas, Inc. 305 Spring Creek Village, Box 521 Dallas, TX 75248-5744 http://www.quiltersguildofdallas.org Part V – Submission Requirements (Applicant MUST include this page) LETTERS OF RECOMMENDATION: Please include Two (2) letters of recommendation. Each letter must address the project for which you are applying as well as the author’s knowledge of the qualifications of the project leader/s and their experience working with them. NUMBER OF COPIES OF APPLICATION: You must submit seven (7) copies (one original and six (6) duplicates) of the complete application, including all required attachments. Failure to supply the correct number of copies or an incomplete application submission, will result in elimination. A cover letter is not required, however, please include and identify each Part of the submission and attachments with tab separations to be collated as indicated below. DVD’s CD’s, Video or any other type of media cannot be returned. METHOD OF SUBMISSION: Submissions are only accepted through the U.S. Mail or overnight delivery services. Proposal submissions made via FAX or email will be eliminated. APPLICATION CHECKLIST: (All items MUST be included in Application) _____ Cover Sheet _____ Part I, Financial Status, completed and signed _____ Part II, Contract Compliance, completed, signed and notarized. _____ Part III, Project Narrative (maximum 5 pages) _____ Part IV, Budget Form (Use separate page to describe “Expense Categories”) _____ Attachments, collated as follows: • “Proposal Narrative Continued”, if added • IRS Determination Letter • Resume(s) of Project Leader/s and committee chairs • Two Letters of Recommendation How did you learn about the QGD Grant Program? Please include the name of the individual, publication, website, or other source: ______________________________________________ Mail completed application to: Quilters Guild of Dallas, Inc. ATTN: Endowment Fund Chair 305 Spring Creek Village, Box 521 Dallas, TX 75248-5744 Applications MUST BE RECEIVED no later than midnight April 30, 2012 Rev. 062911 Page 8 of 8