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 your project. 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 No 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 No 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 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* 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.* CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.