Tipmont REMC Operation Round Up Trust

P.O. Box 20

Linden, IN 47955-0020

ORGANIZATION/AGENCY APPLICATION FOR GRANT

 

1. Name of Organization _____________________________________________________________________

2. Street Address and/or PO Box:_______________________________________________________________

    City, State, Zip Code_______________________________________________________________________

3. Phone #:___________________FAX #___________________email address__________________________ 

4. Contact Person: ________________________________Title_______________________________________

5. Is the organization requesting funding exempt from payment of income tax: Yes___ No ___

A U.S. Treasury Department Letter stating the above named organization is tax exempt under section 501(c)3 of the Internal Revenue Code must be attached to be eligible for a grant.  (An Indiana Sales Tax Exemption Certificate is not Acceptable.)

                                                            NATURE OF REQUEST

l. Describe the project for which you are requesting a grant: _________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

2.  Amount you are requesting: $ _________________________ (Itemized cost estimates must be included.)

     Total Amount needed for Project: $ _________________

     Deadline grant needed by: _________________________

3. Is your organization contributing to the project in terms of cash and/or in-kind/non-cash? If so please provide      the details of the contribution__________________________________________________________________

__________________________________________________________________________________________

4. From what other companies/sources of revenue are you requesting a contribution and for how much?

________________________________________________________________________________________

5. Who will benefit from this project?

________________________________________________________________________________________

6. Number of individuals, families or groups served by your organization/agency in the past year.___________

7. If we support your project, how will you measure its effectiveness and follow-up with us on your results? _______________________________________________________________________________________

8. Are there specific results/outcomes that are expected? ___________________________________________

________________________________________________________________________________________

                                                MORE ABOUT YOUR ORGANIZATION

1.  Do you have a Board of Directors? _________If yes, enclose list_________________________________

2.  What are your total annual operating expenses for year?  $______________________________________

3. What are your total annual fund raising expenses? (As a dollar and/or percent of total operating expense) $_______________________________________________________________________________________

4. Briefly describe your organization’s financial accountability. Are you audited independently on an annual basis?___________________________________________________________________________________ ________________________________________________________________________________________

5. Please list ways we might be recognized for awarding a grant to your organization:____________________

________________________________________________________________________________________

CONTINGENCY PLANNING

If we are unable to award a grant for some or all of your requested amount, what is your backup plan? 

________________________________________________________________________________________

________________________________________________________________________________________

 

THE INFORMATION CONTAINED IN THIS STATEMENT IS FOR THE

PURPOSE OF OBTAINING FUNDING FROM THE TIPMONT REMC

OPERATION ROUND UP TRUST ON BEHALF OF  THE UNDERSIGNED.

EACH UNDERSIGNED UNDERSTANDS THAT THE INFORMATION

PROVIDED HEREIN IS USED IN DECIDING GRANT FUNDING, AND

EACH UNDERSIGNED REPRESENTS AND WARRANTS THAT THE

INFORMATION PROVIDED IS TRUE AND COMPLETE AND THAT THE

TIPMONT REMC OPERATION ROUND UP TRUST MAY CONSIDER

THIS STATEMENT AS CONTINUING TO BE TRUE AND CORRECT UNTIL

A WRITTEN NOTICE OF A CHANGE IS PROVIDED. THE TIPMONT

REMC OPERATION ROUND UP TRUST IS AUTHORIZED TO MAKE ALL

INQUIRIES THEY DEEM NECESSARY T0 VERIFY THE ACCURACY OF

THE STATEMENTS MADE HEREIN.

 ______________________________________________

NAME OF ORGANIZATION:

_________________________________________________________________________________________

SIGNATURE OF REPRESENTATIVE:

_________________________________________________________________________________________

DATE:____________________________________________________________________________________

Enclosures:

                  ____  501 (c) 3 IRS Letter of Determination

                            Itemized Cost Estimates

                            Board of Directors List 

            For Trust Use Only

            __________ Approved Date: ___________ Amount Approved: ____________

TRORT Form 1

TIPMONT REMC OPERATION ROUND UP TRUST

 

APPLICATION GUIDELINES

 

ORGANIZATION/AGENCY

 

 

The role of the Trust Board is to make the best use of the funds entrusted to us to support activities in the surrounding counties and to be sure that whatever gifts we make are handled wisely.

 

Because we want to be helpful to as many organizations as possible, we encourage you to seek funding from more than just Tipmont REMC Operation Round Up Trust.  We will not penalize you for doing that.  In fact, when we see that you have been resourceful – that is, your organization is willing to put some of its own money into a project, and has gotten, or is working on getting, support from other organizations as well – that lends strength to your proposal.  Applications should be submitted before projects are begun.

 

If your organization has funds to complete this project without our assistance, we assume you will fund it yourselves.  Because it helps us to understand the priorities and financial health of an organization, we ask you to provide the requested financial information.

 

Once we have received a request, that request will go to the trust board.  The board is free to support, question or deny any request.  Once the board has approved a request, you will receive written notification, and a check will be issued to the organization.

 

Grant proposals will be reviewed using the following criteria:  a) Is this a 501(c)3 organization?  b)  Is there an established need for the program/project for which the grant is requested?  c)  Is it appropriate for the Trust to make a grant for the requested purpose, or are there more compatible sources of potential funding?  d) Does the trust have adequate resources to effectively respond to this need?  e) Is it good for the surrounding area?

 

The Tipmont REMC Operation Round Up Trust granting cycles are as follows:

 

                        Cycle 1:          1st Monday in January – Deadline for applications

                                                3rd Monday in January – Board Action on grant request

 

                        Cycle 2:          1st Monday in April – Deadline for applications

                                                3rd Monday in April – Board action on grant request

 

                        Cycle 3:          1st Monday in July – Deadline for applications

                                                3rd Monday in July – Board Action on grant request

 

                        Cycle 4:          1st Monday in October – Deadline for applications

                                                3rd Monday in October – Board action on grant request