Form

Community Assistance Fund Application

Date of Application

Organization Name:

Organization Address:

Organization Website:

Contact Name:

Your Title:

Your Email:

Phone Number (format 000-000-0000):

Scheduled Board Meetings (ex. 1st Monday of each month):

Mission or Purpose of Agency:

Population Served:

Tax ID Number (format 00-0000000):

Have you previously applied for funding from Junior League of Mobile?

If so, when?

Amount of funds requested?

Would you accept partial funding? If so, where will the remaining funds come from?

Describe the impact this funding will have on your organization and/or the community (e.g. number of people affected, needs addressed, etc.).

Briefly describe the assistance request and itemize how funds will be spent.

Briefly describe how your program/request fits within the JLM mission and focus area(s).

Project start date:

Is this a new or existing program?

How will you measure success?

What, if any, joint promotional opportunities are available?

Make check payable to:

The following items are required and MUST be uploaded with your Community Assistance Fund application, in order for it to be considered:

Copy of your agency's IRS letter of determination of tax-exempt status.

Fiscal year-end balance sheet and income statement.

Program budget (revenues and expenditures by line item).

If applicable, proof of public school status.

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