Good News Basket Grant Applications
City of Santa Fe, NM tax-exempt organizations that provide services in the areas of education, visual, performing arts, social services, medical services, and environmental conservation may apply. An organization that is operating under the non-profit umbrella of another organization (acting as Fiscal Agent) may also apply, but a copy of the fiscal agency agreement must be provided with this application. No religious entities (except if the entity is serving as a Fiscal Agent for the applicant who is providing services in the Areas of Interest); no political or governmental entities. All applicant organizations must have a sponsor who is a member of the Rotary Club of Santa Fe. Organizations must be in good standing with the New Mexico Attorney General’s Office
Application Window for Proposals: May 29 through June 12, 2015.
Award amount: The typical award is $1,000. No award will be greater than $1,000.
PLEASE MAIL the completed application to the above address. It must be postmarked no later than June 12, 2015.
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The Rotary Club of Santa Fe
P.O. Box 2465
Santa Fe, NM 87504
________________________________________________________________________
2015 - 2016
Good News Basket Grant Application
This form may be reproduced. The application information requested, following the format of this form, may be submitted instead of this form, on no more than two 8.5"X11" sheets of paper, 1" margins, 10pt font, Times New Roman or Palatino. Incomplete applications, no matter how submitted, will not be considered for funding.
Who may apply:
City of Santa Fe, NM tax-exempt organizations that provide services in the areas of education, visual, performing arts, social services, medical services, and environmental conservation may apply. An organization that is operating under the non-profit umbrella of another organization (acting as Fiscal Agent) may also apply, but a copy of the fiscal agency agreement must be provided with this application. No religious entities (except if the entity is serving as a Fiscal Agent for the applicant who is providing services in the Areas of Interest); no political or governmental entities. All applicant organizations must have a sponsor who is a member of the Rotary Club of Santa Fe. Organizations must be in good standing with the New Mexico Attorney General’s Office
Application Window for Proposals: May 29 through June 12, 2015.
Award amount: The typical award is $1,000. No award will be greater than $1,000.
PLEASE MAIL the completed application to the above address. It must be postmarked no later than June 12, 2015.
Applicant Organization Information: (Please type/print/recreate form except for signatures)
Name_____________________________________________________________________
Address___________________________________________________________________
City Santa Fe State New Mexico Zip____________________________________
Date of receiving tax-exempt status ______________________EIN#___________________
Executive Director/Administrator Name__________________________________________
Executive Director/Administrator Signature_______________________________________
Executive Director/Administrator Email ____________________Telephone_____________
Website____________________________________Fax_____________________________
Fiscal Agent's Name (If applicable)______________________________________________
Fiscal Agent's Address________________________________________________________
Fiscal Agent's date of receiving tax-exempt status ___________EIN#___________________
Fiscal Agent's Email ____________________________Telephone_____________________
Fiscal Agent Official Officer or Exec. Dir. Name___________________________________
Fiscal Agent Official Signature _________________________________________________
If using a Fiscal Agent, both a signature for the Applicant and the Fiscal Agent are required. Please include a copy of the Fiscal Agency Agreement with this application.
Please indicate the name of the Rotary Club member who is serving as the official sponsor of your application: _________________________________________________________
Did your organization receive Rotary funding in FY2014? ________In FY2015?_________
Applicant Organization's Primary Area of Service: (circle one that best describes project) Education Visual Arts Performing Arts Social Services Medical/Health Services
Environmental/Conservation
Applicant's Mission Statement:
Applicant's primary activities in fulfilling its Mission: Please, 75 words or less
Applicant's Annual Organization Budget_____________________
Fiscal Year dates__________ Registered with the NM Attorney General (circle) Yes No
If the award will be used for a specific initiative or project of the organization, what is that initiative's or project's annual budget _____________________? Amount of Applicant funds to be used to match the award__________________
How will the Applicant use a Good News Basket Award: Please, 75 words or less
Please describe who will be the primary beneficiaries of the project for which you are requesting a Good News Basket Award. Please, 75 words or less.
Please mail the completed application to: Good News Basket
The Rotary Club of Santa Fe, PO Box 2465, Santa Fe, NM 87504