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Fill and Sign the Donation Request Form Tampa Sky Zone

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 2011 Ampersand Fund Grant Application
 
 Please submit the following information to Bainbridge Community Foundation by April 15, 2011: I. Applicant Information         Organization name Address Contact person and title Contact phone Contact email Organization mission Operating budget (total expenses) for current fiscal year Number of full-time equivalent employees II. Description of Grant Proposal (2 – 3 pages)      Amount requested Type of request: General operations, project/program, or equipment/facility repairs Purpose of grant: Need to be met Action plan: How requested funds will be used Proposal budget: Revenue & expense budget for proposed purpose Note: If grant request is for general operations, no budget information is needed beyond that provided in Section III  Other financial support being sought for proposed purpose  Expected outcomes: Impact of funding on persons served  Sustainability plan: If proposed purpose goes beyond end of grant period how will it be funded in the future? III. Organization Financial Information  IRS Form 990 for most recently ended fiscal year: 990 EZ or 11-page “core form”  If your 990 for the most recently ended fiscal year is available on GuideStar, please so indicate and a copy does not need to be included in your application  If your 990 for the most recently ended fiscal year is not yet available, please provide the date the form will be available to BCF  Balance Sheet (Statement of Financial Position)  Income Statement (Statement of Activities and Changes in Net Assets)  Operating Budget for current fiscal year  Budget vs. Actuals for previous fiscal year IV. Signature and Date Please email completed grant applications to Jean Casey at grants@bainbridgecommunityfoundation.org. Electronic submissions are preferred. If you cannot submit electronically, please drop off or mail two copies to: Bainbridge Community Foundation, 221 Winslow Way West, Box 305, Bainbridge Island, WA 98110 If you have any questions, please call Jean Casey at 206-842-0433. Page 1 of 1 


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