We are dedicated to advancing Human Potential in
Kanawha County, WV through the Arts, Education and Human Services.

Grant Application

Date of Request:

Amount of Request:

Organization Name:

Address:

Name of Contact

Phone:

Fax:

E-mail:

Website:

Organization

History of the organization.

Mission of the organization.

Organization operating budget for current fiscal year.

Summary of Request:

Document the need, problem, or opportunity to be addressed by the project.

State the goals, objectives of the project.

Provide a timeline for project development and implementation.

Estimate number of people to be served.

Describe how outcomes will be determined.

List any project collaborators including their role.

Financial Information:

Provide a line item budget and budget narrative for the project.

Identify other sources of funding for project.

Other attachments required:

IRS tax exempt determination letter

Organization current fiscal year budget

Most recent audit, if available

Financial statements for last three fiscal years

List of Directors and officers