Foundation application

Applicant Summary

Please provide general information about you or your organization and contact details. This information will be used to create or update our grant record system. Include any supporting materials e.g. photos/receipts/estimates, with this form.

1.0 BASIC INFORMATION

First Name

Last Name

Organizational name

if applicable

Title

if applicable

Phone

Country

(###)

###

####

Mailing address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Website

if applicable

http://

2.0 If you are an organization - individuals can skip this section, continue from section 3.0 Project Overview.

2.1 Are you a 501(c)(3) nonprofit with the IRS

Yes

2.2 EIN

a. Include a copy of your organization’s official notice of tax-exempt status from the IRS with the completed application. b. Include a copy of your organization’s current Board of Directors list with the completed application. c. If you are an educational institution, include administrative staff list and your district’s W-9 form with the completed application.

2.3 Organization mission

2.4 Organization core services

2.5 Estimated number of volunteers

2.6 How do you engage volunteers to further your mission?

3.0 PROJECT OVERVIEW

3.1 Project title

3.2 Brief summary of project

3.3 How many people will be impacted?

3.4 Please select the area of focus:

Is this request related to disaster relief?

YES

If NO (Continue below) If YES (Spruce Pine Foundation disaster relief awards are capped at $5,000 per household/ organization. If your application is related to disaster relief, you need only fill in the following sections - 3.5.1 Describe geographic location, 3.5.2 Describe project in more details, 3.5.3 What makes your need unique and 3.6.4 Grant request amount.)

Drive for economic development and diversified growth

Support for community organizations and social initiatives

Development for infrastructure improvements and building a connected community

Respect for the Blue Ridge Mountain land and preservation of the ecosystem for future generations

3.5 Detailed Project Summary

3.5.1 Describe geographic location

3.5.2 Describe project in more details with timelines and how you would use the funds.

3.5.3 What makes your need unique?

3.5.4 What will make you or your organization effective in achieving the results of the project?

3.5.5 Do you need licensing, zoning, permitting or other regulatory approvals?

3.5.6 Are you working with other organizations on the project?

3.5.7 Please list who you have chosen to partner with and why.

3.6 Results Description and Project Budget

3.6.1 What results will you achieve from this grant? How will you know if they are successful?

3.6.2 Total project budget

3.6.3 Detailed project expenses

3.6.4 Grant request amount

4.0 SUBMITTAL PAGE

Review all sections before submitting your application, ensuring all information has been provided and necessary attachments have been included. The Foundation reserves the right to ask for additional information in order to make a final decision on your grant application Certification By submitting this application you certify that all information provided is accurate to the best of your knowledge and the project and schedule as presented will be adhered to. You certify that you are submitting the application with the proper authority, either as yourself or acting on behalf of an organization.

Signature of representative for grant request

Date of application

YYYY

Personal data info

By providing your personal data and submitting this application, you agree and consent to us collecting and processing your personal data for purposes of processing your application and as further set forth in our privacy policy, which can be found at www.sibelco.com/en/privacy

Foundation application

Sibelco Spruce Pine Foundation

Location