Grant Application for OVER $2,500

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Cover Sheet

Please complete the fields on each page. Note that some fields (*) are required before moving to the next page. You may save at any time by clicking the save icon at the bottom right of the form. If you are not able to complete the entire form, you can come back later and finish. Please do not clear your browser cache or delete your cookies until the application is completed.

Name of Organization*

Name

Address of Organization*

Address line one

Address line two

State

Postal Code

Organization’s Federal Tax Identification Number

If Applicable

ID Number

Contact Person's First Name*

First Name

Contact Person's Last Name*

Last Name

Contact Person's Email*

Phone Number*

Phone

Fax Number

Fax

Web Address

URL

Project Title*

Title

Total Project Budget*

Amount

Total Funding Request*

Amount

Grant Period Start Date*

Date ×

Grant Period End Date*

Date ×

Dates of Prior JPMF Grants Received

If Applicable

Dates

Amounts of Prior JPMF Grants Received

If Applicable

Amounts

Executive Summary of Project*

Summary

Organizational Background

Organizational Background*

Provide a brief history of your organization including general purpose or mission of the organization and its objectives. Describe scope of operations, current major programs for services and the population served as well as location of service activities. Describe the major accomplishments and capabilities of your organization, highlighting accomplishments of the past year. Limit to one page.

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Statement of Purpose*

Explain the problem, need or issue for which the grant is requested, and an estimate of the number of those who will benefit. Discuss how this request will enable your organization to improve its ability to meet program or organizational goals. Limit to 50 words.

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Program Implementation and Evaluation Plan*

Describe how you will utilize the grant funds to further JPMF’s mission of improving the lives of idividuals with special needs and their families. What existing community resources (facilities, people) will be used? List specific outcomes or objectives for the project and describe actions to be taken to achieve them. Discuss how you intend to measure progress toward and attainment of objectives and outcomes. Provide a timeline of project activities, including major planning and implementation milestones. Describe the resources (financial, partnerships, personnel) that might be used to sustain this project over time. Limit to one page.

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Staff Qualifications (If Applicable)

Describe the qualifications and experiences of the principal staff members and instructors of the project in relation to its objectives. If project staff have not yet been hired, please provide job description(s).

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Budget Summary

Please complete the attached budget template. In the narrative section for each category, explain each item included in the budget, its relevance to the project, and how the budget amount was determined (i.e., calculations). Include the source of all in-kind funds and describe any additional revenue, such as fees. Also include plans for continued funding of the program at the expiration of the grant period.

Supplies and Equipment (If Applicable)

Grant Request

Amount (no commas)

In-Kind

Amount (no commas)

Contracts (If Applicable)

Grant Request

Amount (no commas)

In-Kind

Amount (no commas)

Other (If Applicable)

Grant Request

Amount (no commas)

In-Kind

Amount (no commas)

Total (If Applicable)

Request Total

$ 0

In-Kind Total

$ 0

Notice

Grant funding may not be used for the following:

Indirect, overhead, or administrative costs
Fundraising activities
Projects that will result in profit for the applicant
Salaries of existing staff members

Personnel

Position 1 (If Applicable)

Position 1

Position

Rate

Hours / % of time

Hours/%

Grant Request

Amount (no commas)

In-Kind

Amount (no commas)

Position 2 (If Applicable)

Position 2

Position

Rate

Hours / % of Time

Hours/%

Grant Request

Amount (no commas)

In-Kind

Amount (no commas)

Position 3 (If Applicable)

Position 3

Position

Rate

Hours / % of Time

Hours/%

Grant Request

Amount (no commas)

In-Kind

Amount (no commas)

Position 4 (If Applicable)

Position 4

Position

Rate

Hours / % of Time

Hours/%

Grant Request

Amount (no commas)

In-Kind

Amount (no commas)

Position 5 (If Applicable)

Position 5

Position

Rate

Hours / % of Time

Hours/%

Grant Request

Amount (no commas)

In-Kind

Amount (no commas)

Fringe Benefits (If Applicable)

Benefits Grant Request

Amount (no commas)

Benefits In-Kind

Amount (no commas)

Total

Grant Request Total

$ 0

In-Kind Total

$ 0

Personnel Narrative

Write Here

Supplies and Equipment

Description 1 (If Applicable)

Description 1

Write Here

Rate

Amount

Write Here

Grant Request

Amount (no commas)

In-Kind

Amount (no commas)

Description 2 (If Applicable)

Description 2

Write Here

Rate

Amount

Write Here

Grant Request

Amount (no commas)

In-Kind

Amount (no commas)

Description 3 (If Applicable)

Description 3

Write Here

Rate

Amount

Write Here

Grant Request

Amount (no commas)

In-Kind

Amount (no commas)

Description 4 (If Applicable)

Description 4

Write Here

Rate

Amount

Write Here

Grant Request

Amount (no commas)

In-Kind

Amount (no commas)

Description 5 (If Applicable)

Description 5

Write Here

Rate

Amount

Write Here

Grant Request

Amount (no commas)

In-Kind

Amount (no commas)

Total

Grant Request Total

$ 0

In-Kind Total

$ 0

Supplies and Equipment Narrative

Write Here

Contracts

Description 1 (If Applicable)

Description 1

Write Here

Rate

Amount

Write Here

Grant Request

Amount (no commas)

In-Kind

Amount (no commas)

Description 2 (If Applicable)

Description 2

Write Here

Rate

Amount

Write Here

Grant Request

Amount (no commas)

In-Kind

Amount (no commas)

Description 3 (If Applicable)

Description 3

Write Here

Rate

Amount

Write Here

Grant Request

Amount (no commas)

In-Kind

Amount (no commas)

Description 4 (If Applicable)

Description 4

Write Here

Rate

Amount

Write Here

Grant Request

Amount (no commas)

In-Kind

Amount (no commas)

Description 5 (If Applicable)

Description 5

Write Here

Rate

Amount

Write Here

Grant Request

Amount (no commas)

In-Kind

Amount (no commas)

Total

Grant Request Total

$ 0

In-Kind Total

$ 0

Contracts Narrative

Write Here

Other

Description 1 (If Applicable)

Description 1

Write Here

Rate

Amount

Write Here

Grant Request

Amount

In-Kind

Amount (no commas)

Description 2 (If Applicable)

Description 2

Write Here

Rate

Amount

Write Here

Grant Request

Amount (no commas)

In-Kind

Amount (no commas)

Description 3 (If Applicable)

Description 3

Write Here

Rate

Amount

Write Here

Grant Request

Amount (no commas)

In-Kind

Amount (no commas)

Description 4 (If Applicable)

Description 4

Write Here

Rate

Amount

Write Here

Grant Request

Amount (no commas)

In-Kind

Amount (no commas)

Description 5 (If Applicable)

Description 5

Write Here

Rate

Amount

Write Here

Grant Request

Amount (no commas)

In-Kind

Amount (no commas)

Total

Grant Request Total

$ 0

In-Kind Total

$ 0

Other Narrative

Write Here

Sustainability

Please describe plans for continuing the project after the grant period ends.

Sustainability Narrative*

Write Here

Attachments

Document 1

IRS Exemption (If Applicable)

A copy of the applicant’s current IRS tax-exempt determination letter, unless applicant is a local government agency. If tax-exempt status is pending, provide an explanation of application status. You must receive your 501(c) (3) determination prior to the beginning of the grant program.

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Max file size: 9.54 MB. | Allowed file types: pdf,rtf,doc,docx,jpg,jpeg,png,csv,xlsx,xls

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Document 2

990 Form (If Applicable)

A copy of the applicant’s most recent 990 forms.

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Max file size: 9.54 MB. | Allowed file types: pdf,rtf,doc,docx,jpg,jpeg,png,csv,xlsx,xls

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Document 3

Other Organizations (If Applicable)

If other organizations will participate in the proposed activities, please provide the name(s) of the organization(s), and a letter from the organization describing their role and the specific activities in the operational plan they have agreed to implement and any resources they intend to provide.

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Max file size: 9.54 MB. | Allowed file types: pdf,rtf,doc,docx,jpg,jpeg,png,csv,xlsx,xls

Select Files

Document 4

NOTICE

Please review all of your information before clicking the submit button below.
You are free to go back to previous pages if necessary.
Once you click submit, you will not be able to change any information.

Once your application is submitted you will receive a confirmation email that includes a copy of your application.

You will also be able to Print your application after you submit it.

Cover Sheet

Organizational Background

Budget Summary

Supplies and Equipment (If Applicable)

Contracts (If Applicable)

Other (If Applicable)

Total (If Applicable)

Notice

Personnel

Position 1 (If Applicable)

Position 2 (If Applicable)

Position 3 (If Applicable)

Position 4 (If Applicable)

Position 5 (If Applicable)

Fringe Benefits (If Applicable)

Total

Personnel Narrative

Supplies and Equipment

Description 1 (If Applicable)

Description 2 (If Applicable)

Description 3 (If Applicable)

Description 4 (If Applicable)

Description 5 (If Applicable)

Total

Supplies and Equipment Narrative

Contracts

Description 1 (If Applicable)

Description 2 (If Applicable)

Description 3 (If Applicable)

Description 4 (If Applicable)

Description 5 (If Applicable)

Total

Contracts Narrative

Other

Description 1 (If Applicable)

Description 2 (If Applicable)

Description 3 (If Applicable)

Description 4 (If Applicable)

Description 5 (If Applicable)

Total

Other Narrative

Sustainability

Attachments

Document 1

IRS Exemption (If Applicable)

Document 2

990 Form (If Applicable)

Document 3

Other Organizations (If Applicable)

Document 4

Other Documents (If Applicable)

NOTICE

Your form has been submitted