Grant Application Form

Phone

This field is for validation purposes and should be left unchanged.

Applicant Organization's Name:*

Address:*

City*

State*

Zip*

Phone*

Name of Executive Director:*

Phone Number of Executive Director:*

Email of Executive Director:*

Name of Person Submitting Request:*

Title of Person Submitting Request:*

Phone Number of Person Submitting Request :*

Email:*

EIN#*

United Way funded*

Yes

Website Address*

Referred by (if any)*

Previous Grants Received from East Missouri Foundation (amounts and years)*

Area of Charitable Service:*

Safe and Affordable Housing

Health Care

Food Services

Transportation

Mission (Describe the purpose of your organization - 1,000 character limit):*

Services provided by your organization (list all services that represent 5.0 percent or more of your budget - 1,000 character limit):*

Area served by organization (check all that apply):*

St. Louis City

St. Louis, St. Charles, Jefferson Counties

Other St. Louis Metropolitan Statistical Area (MSA) Counties

Year organization established:*

Year received tax-exempt status:*

Number of employees:*

Budget for most recent year end:*

Contributions received for most recent year end:*

If funded in previous year, describe your goals for the funded project and report your results, including any data indicating that you met these goals (1,000 character limit):

Name of accounting firm that handles audit and review of funds:*

Contact name:*

Contact phone:*

Can the foundation contact the accounting firm for additional information?*

Yes

Describe your proposed project (i) through (iii) below. Include (i) the purpose and goals of your project (1,000 character limit);*

(ii) the class of individuals served by the project, the number of individuals served by the project, and the location of those individuals (1,000 character limit);*

(iii) the way in which you will measure the success of your project (1,000 character limit).*

Applicant fiscal year end:*

Amount requested:*

Upload Required Attachments (ensure all attachments are included before submitting; grant applications missing required supporting documents will not be considered):*

Drop files here or

Accepted file types: jpg, gif, png, doc, docx, pdf, xlsx, Max. file size: 50 MB, Max. files: 15.

IRS tax determination letter showing that you are a recognized public charity 501c3 or 509 (1) (1-3) and that you are not a private foundation*
Affidavit from a representative of your organization stating that the IRS has not revoked your tax-exempt status or changed that status since the issuance of the tax determination letter*
List of the Board of Directors or trustees, showing name, corporate title, volunteer title, address and phone number*
Audited Financial Statement*
Most recent IRS Form 990*
List of Funders and amounts (above $1,000)*
Current year's operating budget (to include both projected expenses and revenues - categorize expenses under program, general and administration and fundraising)*
Project Budget (expenses and income) - attach if applicable*
Grant Report from previous year's grant (if applicable); the Grant Report Form can be found and uploaded on East Missouri Foundation's website home page under the Grant Report Form column.*

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