Grant Application Grant Application NEW 11/4 "*" indicates required fields 2023 GRANT APPLICATION TO KENTUCKY SOCIAL WELFARE FOUNDATION Grant applications are considered for funding if the proposed project aligns with the following Purpose statement: Grant applications to the Kentucky Social Welfare Foundation must be for a use that is consistent with the Foundation’s charter and its purposes: The purpose of KSWF is to improve quality of life and opportunity among Kentuckians who experience diminished economic opportunities, whether due to poverty, poor health, disability or inequality. Targeting our grants to rural areas, small towns, and geographic areas of special need, KSWF seeks to promote efficient and effective social welfare organizations and methods for providing “self-help and training.” KSWF fulfills this purpose through monetary grants to established non-profit organizations that will (1) “enlarge and broaden their scope of operation” and/or (2) develop and implement “new projects to provide services which no agency, already in operation, is planned or equipped to extend.” The Kentucky Social Welfare Foundation will not provide grants toward capital campaigns, periodic funds appeals, or for ongoing operational expenses.I. AGENCY DESCRIPTIONName of Applicant/Organization* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email Address* President/Executive Director/Contact Person* First Last Grant Request ($ Amount)*Project Title* Project Begin Date* Month Day Year Project End Date* Month Day Year List the Agency’s mission and vision*Describe the agency’s service area with regard to population, cultural, racial and ethnic makeup.*Indicate total number of paid staff and total number of volunteers.*II. PROJECT DESCRIPTION AND BUDGETDescribe the proposal in a detailed narrative of services and benefits it will provide in improving standards of living and opportunities, meeting social purposes or responding to needs.*Attach Project Budget*BEFORE UPLOADING, please name your pdf in the following manner, beginning with the date of upload followed by the letters "PB" and the organization name (or an abbreviated version of it): mm.dd.yyyy.PB.nameoforganization ex: 06.07.2018.PB.peoplescharityAccepted file types: pdf, Max. file size: 512 MB.Provide a narrative that clearly defines how KSWF funds will be used and accounted for in relation to the Narrative above. Provide start dates/timelines for tasks.*III. REASONS FOR REQUESTING GRANTDescribe why this project is needed and how it implements the purpose of the KSWF*Does any other organization in community serve this need?* Yes No If so, what is the agency and what distinguishes your agency’s services from others?*IV. PROJECT FOLLOW-UPDescribe how you will measure outcomes of this proposal (i.e., productivity, efficiency, cost-effectiveness in terms of numbers impacted, numbers served, numbers trained, etc.)*After the grant funds are expended, describe how you will sustain grant-funded services and/or equipment maintenance.*V. FINANCIAL INFORMATIONWhat fees or charges are made by the organization for its services?*If applicant has ever received prior grants from the KSWF, provide dates, amounts, purposes, and outcomes. Also, please note if your organization has received funds under a different name.*Attach Agency Budget (local budget is all that is needed if part of a larger organization)*BEFORE UPLOADING, please name your pdf in the following manner, beginning with the date of upload followed by the letters "AB" and the organization name (or an abbreviated version of it): mm.dd.yyyy.AB.nameoforganization ex: 06.07.2018.AB.peoplescharityAccepted file types: pdf, Max. file size: 512 MB.Attach IRS 501(c)(3) tax designation letter*BEFORE UPLOADING, please name your pdf in the following manner, beginning with the date of upload followed by the numbers "501" and the organization name (or an abbreviated version of it): mm.dd.yyyy.501.nameoforganization ex: 06.07.2018.501.peoplescharityAccepted file types: pdf, Max. file size: 512 MB.Attach 990 or 990-PF federal tax return*BEFORE UPLOADING, please name your pdf in the following manner, beginning with the date of upload followed by the numbers "990" and the organization name (or an abbreviated version of it): mm.dd.yyyy.990.nameoforganization ex: 06.07.2018.990.peoplescharityAccepted file types: pdf, Max. file size: 512 MB.Attach any additional documents you wish to include with this application.BEFORE UPLOADING, please name your pdf in the following manner, beginning with the date of upload followed by an abbreviation of the document's name and the organization name (or an abbreviated version of it): mm.dd.yyyy.XYZ.nameoforganization ex: 06.07.2018.XYZ.peoplescharity Drop files here or Select files Accepted file types: pdf, Max. file size: 512 MB. VI. FeedbackHow did you hear about KSWF? Facebook Email Other Other?Please tell us how! Sign and SubmitI, Name* First Last Select* President CEO Other (Executive Director) of the applicant organization state that I am authorized to sign and submit this application and that all statements, facts, figures and representations made in the application and attachments are true, that any funds awarded as a result of this grant will be spent in accordance with the attached budget to implement the described project and in accordance with any special conditions established by the Kentucky Social Welfare Foundation, that all applicable federal and state laws and program procedures will be implemented to insure proper project management and fiscal control to assure accountability of grant funds, and that a final report describing how the project met its intended purposes (including the number of beneficiaries and other objectives accomplished) will be submitted within 13 months to the Kentucky Social Welfare Foundation. Applicant hereby agrees to indemnify the Kentucky Social Welfare Foundation from any liability or loss arising from the implementation of this grant. The applicant further agrees to return to the Kentucky Social Welfare Foundation any awarded funds that exceed the actual cost of the above project. Applicant acknowledges that failure to adhere to all conditions may result in forfeiture and return of all grant funds.Signature*Date* Month Day Year Failure to provide requested information may result in application being disqualified.