Application for Funding

To Our Altrusa Sisters:

Attached you will find a form that the Foundation Board has created to assist our club in finding new projects for our membership to support.  In the past we have had members bring new project ideas to our club and along with the new project there were always many questions.  The form we have created answers most of the questions that members usually ask, and other questions that should be asked as we grow as a club. The purpose of this form is not to intimidate anyone but to make our club more professional both in its support of the non-profits that we do help out and to businesses looking for places to donate their funds. If you know of an organization that is interested in asking us for funds and/or volunteer support, please give them this form and have them give it to you or send it to one of us.

Please do not let the length of the form or the questions on this form stop you from bringing a new idea to our club.  The entire Foundation Board is here to help you fill out the form, should you need assistance.  There may be some questions that will not be applicable to the project you are presenting; there may be questions that you don’t know the exact answer, which is ok.  Just fill it out to the best of your ability and we can help you fill in the blanks.

Please feel free to email any of us with questions:

Linda Hurt, President

Virginia Palmeri, Vice President

Jane Craven, Treasurer

Alison Specht, Secretary

, Member-at-Large

 

 

 

ALTRUSA INTERNATIONAL FOUNDATION, INC. of DFW

 

Application for 2014- 2015 Community Support

 

Summary of Request

Name of Organization:_____________________________________________    

Address:_________________________________________________________ 

Location where Altrusa volunteers will work: ____________________________

Telephone: _________________________   Fax: ________________________

E-mail address: _______________________________

Executive Director: ________________________________________________

Altrusa Sponsor for Application:   _____________________________________

All financial donations from Altrusa International Foundation Inc. of DFW must be spent in the fiscal year for which they are granted. The Altrusa fiscal year runs January 1 to December 31.

 

Project/program name: ______________________________________________

Total funding requested: ______________ Total volunteers requested: _________

Purpose of project/program: __________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

 

How will Altrusa support (volunteers, funds, or both) generally be used?

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

 

Specifics of Project/Program

Community Needs:

What specific community needs will this project/program meet?

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

 

What other community agencies or groups provide the same or similar services or are attempting to address the same community needs?

___________________________________________________________________

___________________________________________________________________

Clients:

How many clients will be served by this project/program? ____________________

How are clients referred or selected? _____________________________________

How will clients receive services? _______________________________________

___________________________________________________________________

What geographical areas are primarily served? _____________________________

Will clients pay for services?  If so, how much? ____________________________

 

Volunteers:

Please describe the volunteer component of this request for each different volunteer position requested.

 

Name of position: __________________  No. of volunteers: _________________

Job description: ___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

 

Time commitment (including days, times, and total requested per volunteer):

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

 

Training you will provide (type and length): _______________________________

__________________________________________________________________

 

Total number of non-Altrusa volunteers currently involved in project/program? ___

 

Will volunteer be subjected to any special risk to health or personal safety? ______

If so, please describe: ________________________________________________

 

Will volunteers need to take health precautions? ____________________________

If so, please describe: ________________________________________________

 

Do you perform criminal background checks on volunteers? ______ staff? ______

Funding:

Total budget for this project/program: ____________________________________

Total Altrusa funds requested for this project/program: ______________________

Altrusa funds requested will be used as follows (please provide a detailed line-item

budget):

____________________________________________  $ ___________________

____________________________________________  $ ___________________

____________________________________________  $ ___________________

____________________________________________  $ ___________________

____________________________________________  $ ___________________

____________________________________________  $ ___________________

____________________________________________  $ ___________________

 

                                                                        TOTAL:    $ __________________

If total project/program cost exceeds Altrusa funding, how will organization secure

remaining funds? ____________________________________________________

 

Please indicate range of project/program funding between minimums necessary to initiate or continue project/program and ideal amount required to make project/program highly successful: __________________________________________________________________

___________________________________________________________________

___________________________________________________________________

Organization Information

History:

Please briefly describe the organization, its history, purpose and mission: ________

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

 

How many clients has the organization served annually for the last five years? ____

 

Has the organization previously submitted a request to (or otherwise received support from) Altrusa? ___________ If so, please describe the year of the request or grant as well as the type of support requested or granted: __________________________________________________________________

 

SUPPORTING DOCUMENTATION

Please provide a copy of the organization’s nonprofit status.

We reserve the right to request any of the additional information listed below:

Description of current community partnerships, alliances or coalitions

  1. Organizational chart
  2. List of Board of Directors
  3. Most recent annual report
  4. Most recent audited financial statements
  5. Current fiscal year operating budget

 

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