Legal Name of Organization
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Organization Address
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Phone
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(###)
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Chief Officer or Executive Director
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First Name
Last Name
Phone
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Chief Officer or Executive Director Phone #
(###)
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Contact Person / Project Director
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Phone
Contact Person / Project Director Phone #
(###)
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Year Founded
Federal Tax ID #
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Geographic Area Served
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Number of Youth Served Annually
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Mission Statement
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Is Organization exempt under IRS 501(c)(3) guidelines (or earlier versions)?
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Is Organization exempt under 509(a) guidelines (public charity)?
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Is Organization legally affiliated with any other organizations?
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If yes, please list:
Has your Organization received funding from The Saguaros (Scottsdale Active 20/30 Foundation) in the last 2 years?
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If so, what did you use the funds for? Was the intended project or event completed?
If the Organization was the recipient of funding from the agencies below, please check all that apply:
Please list size and source of 5 largest grants other than the government and United Way grants listed above:
(Organization Name, Current Year Amount, Previous Year Amount)
Number of Full Time Employees:
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Number of Part Time Employees:
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Number of Volunteer Employees:
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Number of Full Time Directors on Board:
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Number of Part Time Directors on Board:
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Number of Volunteer Directors on Board
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Grant Amount Requested:
Project Description
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Briefly describe the nature, scope, goals, and current status of the project for which the grant is requested (3000 character limit).
What need is addressed by this project, and what is its linkage to the goals of the organization?
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Who will benefit from this project?
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Are other groups providing similar services?
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If 'yes', what distinguishes your project, or how does it complement others?
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Is this project being done in conjunction with (or in collaboration with) any other organization or nonprofit group(s)? If yes, please list:
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Project Start Date:
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Project End Date:
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Describe the measurements that will be used to assess the success and effectiveness of the project, both short-term and long-term, as they relate to the project goals:
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Total Project Cost / Budget:
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Percent of current year's budget:
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List funding from other private or public sources which has been received or is under consideration for this project.
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Source, amount and duration of funding (i.e. start and end dates):
Are matching or challenge grants associated with this project? If yes, please list:
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Describe the plans for sustaining this project in future years (maintenance, etc.):
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