GRANTS

2019 Community Grant Application

Click here to print a mailable form.

1. AGENCY PROFILE
Organization Name*
Primary Contact*
Position*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Charitable Registration #*
Date of Incorporation*
Website*
# of Full Time Employees*
# of Part Time Employees*
# of Volunteers*
Previous Grants
Please list previous grants received from the Brandon Area Community Foundation.
Date: Purpose: Amount:
Was Final Grants Report filed:
- Yes
- No
2. AGENCY INFORMATION
What is the purpose of the organization?*
What services are provided? (include target population, geographic area served, and number of people served)*
3. GRANT REQUEST
Amount Requested*
Total Cost of Project*
Project Start Date*
Completion Date*
Please provide the project description on a separate word document and attach with application*
Sources of Funding
Please identify other sources of funding and dollar amounts for this project.
Name Amount Confirmed? (Y or N)
Partial Funding - Would your organization be able to continue the initiative if you were to receive only partial funding in support of your request?*
- Yes
- No
If yes, please elaborate:
Is your local Community Foundation a Funding Partner?*
- Yes
- No
If yes, please elaborate:
If no, please elaborate:
How will this project be evaluated?
If your project is successful, how will your organization recognize BACF and other funding partners?
6. COMMUNITY REFERENCES
Please provide the name, phone number and contact person of two organizations who may be contacted by the Brandon Area Community Foundation in support of your organization's application for funding.
1. Organization Name*
Contact Person*
Email
Phone*
2. Organization Name*
Contact Person*
Email
Phone*
4. ATTACHEMENTS TO BE INCLUDED:
Please check off all items*
- Most current audited or reviewed financial statement
- Total revenue and expense budget for the current year
- Budget for proposed project
- List of current Board Members and contact information
Files*
Drop files here or
5. AUTHORIZATION
This application must be signed by an officer of the organization's Board of Directors (Chair/President, Vice-Chair/Vice-President, Treasurer, Executive Director or General Manager of the organization). By signing this application the applicant agrees to the grant terms and conditions and gives BACF permission to publish photos, grant recipient stories, and grant information upon approval of the grant. Grant applications, which are not approved, will remain confidential.
Name*
Title First Last
Phone*
Date*
Signature*
Name
This field is for validation purposes and should be left unchanged.

Completed application and required supporting documents must be submitted to BACF by Monday, September 30th, 2019 at 4:30 PM.

For more information contact:
Laura Kempthorne, Executive Director
Phone: 204-571-0529
Email: laurak@bacf.ca
Website: www.bacf.ca

Disclaimer: BACF is not responsible for electronic applications not received.
Any personal information requested on this application will only be used to assist with the assessment of your grant application.

GRANTS

2019 Community Grant Application

1. AGENCY PROFILE

2. AGENCY INFORMATION

3. GRANT REQUEST

6. COMMUNITY REFERENCES

4. ATTACHEMENTS TO BE INCLUDED:

5. AUTHORIZATION

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Date:	Purpose:	Amount:

Name	Amount	Confirmed? (Y or N)