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. URLThis 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 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.* CAPTCHA