Grant Application *Our 2024 grant application window opens April 15, 2024. Water Buffalo Club Grant Application Form Grant Requests Requested Amount ($) This Request is for Specify (if other) Program/Project Title Organizational Information Organization Name Address City State State... None -- UNITED STATES -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming -- CANADA -- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory -- AUSTRALIA -- Australian Capital Territory New South Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia Zip Telephone Email Fax Executive Director Telephone Name of Contact Person Title Telephone Total Organization Budget for Current Year ($) Date of Incorporation United Way Funded FEIN Number (or equivalent) Is your organization tax exempt under Section 501(c)(3)? Section 509(a)? If not, do you have a fiscal agent? (Please identify organization, contact person, and telephone number) Summarize the organization's mission (2-3 sentences) Geographic service area(s) (Please be specific) Total number of people serviced by your organization Provide percentages and/or descriptions of the populations your organization serves. Male(%) Female(%) Total % should equal 100% Up to Age 6 (%) 7-12 years old (%) 13-17 years old (%) 18+ years old (%) Total % should equal 100% Staff Composition in Numbers Paid Full-Time Support Professional Total Salaries Paid Part-Time Support Professional Total Salaries Volunteers Support Professional Total Salaries Interns Support Professional Total Salaries Other Support Professional Total Salaries Totals Support Professional Total Salaries Summarize the specific purpose of your request (5 sentences or fewer) Time frame in which the funds will be used From To How many people will be serviced by this funding request? List other private and public funding sources for this particular request Funding Sources - to date Amount ($) Date Received Funding Sources - pending Amount ($) Date Received Organizational Budget (last fiscal year) Total Expenses ($) Total Revenues ($) Authorized Signature Signature of Authorized Official Date Name Title Required Attachments A. Finances 1. Audited or unaudited financial statements for the last fiscal year, if available, or Form 990. Choose a file 2. Current year's operating budget to include both projected expenses and revenues. Categorize expenses under program, general and administrative, and fundraising. Choose a file 3. Annual Capital budget. Choose a file 4. A list of foundations, corporations, or governmental agencies which funded the organization in the last fiscal year, including amounts contributed ($2,500 and above). Choose a file 5. Itemization of use of requested funds. Choose a file 6. Bios of all organizational executives. Choose a file B. Other Supporting Materials 1. Verification of the organization's or fiscal agent's tax-exempt status under Section 501(c) 3 and 509(a) of the IRS code. If using a fiscal agent, please include Letter of Authorization. Choose a file 2. Latest annual report or a summary of the organization's prior year's activities. Choose a file 3. Current board list with contact information and related employment affiliation. Choose a file 4. Letters of support and/or reviews (if applicable). Choose a file Save