Grant Application Form Please complete all of the following information to apply for a charitable service project. Please be as descriptive as possible to help our board allocate the necessary funds to each project. Applicant Organization's Name:* Address:* City* State* Zip* Name of Person Submitting Request:* Title of Person Submitting Request:* Phone:*Fax:*EIN#* United Way funded* Yes No Website Address* Referred by (if any)* Previous Grants Received from East Missouri Foundation (amounts and years)* Email:* Area of Charitable Service:* Safe & Affordable Housing Health Care Food Services Transportation Other Services Mission (Describe the purpose of your organization - 1,300 characters):*Services provided by your organization (list all services that represent 5.0 percent or more of your budget - 1,300 characters):*Area served by organization (check all that apply):* St. Louis City St. Louis, St. Charles, Jefferson Counties St. Louis MSA Year organization established:* Year received tax-exempt status:* Number of employees:* Budget for most recent year end:* Contributions received for most recent year:* 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 (1,300 characters):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 No Describe your proposed project (i) through (iv) below. Include (i) the purpose and goals of your project (1,300 characters);*(ii) the statement of need for your project (1,300 characters);*(iii) the class of individuals served by the project, the number of individuals served by the project, and the location of those individuals (1,300 characters);*(iv) the way in which you will measure the success of your project. You may use this space and attach up to one additional page if necessary (1,300 characters).*Describe the implementation process for your project. Be sure to include information on key staff and volunteer project managers (1,300 characters).*Describe the evaluation process for your project, including expected outcomes in items (i) through (iv) below. Outline (i) the evaluation process (1,300 characters),*(ii) the individuals responsible for measuring and reporting the outcome of the project (1,300 characters),*(iii) the statistical manner in which results will be calculated (1,300 characters),*(iv) a description of how the project will be funded in future years (1,300 characters).*Applicant fiscal year end:* Time period for budget attached:* Amount requested:* Time period for payment:* Upload Required Attachments (ensure all attachments are included before submitting; missing documents may affect consideration):* Drop files here or Select files 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 CAPTCHANameThis field is for validation purposes and should be left unchanged.