New Grant Application Step 1 of 4 25% Section 1: Applicant InformationOrganization Name:(Required)Physical Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Mailing Address(if different from physical address) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Your Email Address Your PhoneWebsitePrimary Contact Name & Title Name Title Federal EIN Section 2: Applicant Type (Check One)Application Type(Required) 501(c)(3) Non-Profit For-Profit Entity Government Agency Other If Other (Please Specify):Section 3: Grant Request DetailsType of Request(Required) One-Time Grant Requesting Consideration for Ongoing/Recurring Support Total Amount Requested: per month $or Total amount $Brief Summary of Purpose for Grant Funds and include the geographic area(Required) Section 4: Grant History & Funding SourcesHave you previously received funding from Faith, Hope and Charity? Yes No If Yes, please specify amount(s) and year(s):Have you received any grants from other funders within the last 3 years? Yes No If Yes, please list your three largest grant funders and amounts and brief purpose:Funder Name - 1Amount - 1Year - 1Purpose -1Funder Name - 2Amount - 2Year - 2Purpose -2Funder Name - 3Amount - 3Year - 3Purpose -3Please list other current sources of revenue (check all that apply): Individual Donations Special Events Federal/State Funding Church/Religious Support In-Kind Donations Program Service Fees Other If other, please explain Section 5: Organizational MissionPlease provide your organization's mission statement:Section 6: Use Of Grant FundsDescribe how the requested grant funds will be used:(Be specific. Include what programs, services, supplies, personnel, or operational expenses will be supported. Attach budget if available and additional pages if needed.)Section 7: Sustainability PlanHow will your organization sustain this project or program after this grant period ends?(Describe any fundraising plans, partnerships, or revenue sources that support ongoing efforts.)Section 8: Required AttachmentsUpload AttachmentsIf this is your first time applying or you have not received a grant from Faith, Hope and Charity in the past three years, please attach the following: A list of your current board members with names and roles, a copy of your most recent IRS Form 990, your current annual operating budget, last year profit and loss as well as a balance sheet, any additional documents that support your application (optional) Drop files here or Select files Accepted file types: pdf, doc, docx, Max. file size: 25 MB. Section 9: Authorized SignatureAuthorized SignaturePrinted Name & Title:Date: Δ
