Form

Thank you for submitting your grant application. It is anticipated that the Sussex County Council will consider these requests in October and awards will be made during the month of November.

Section1: Applicant Information

Legal Name of Agency/Organization *

Project Name *

Federal Tax ID *

If you are using a GROUP Federal Tax ID from the IRS, you must provide a copy of the annual report filed with the IRS to show that your organization still falls under that GROUP Federal Tax ID

Allowed file types: pdf doc docx.

Non-Profit *

Please include a copy of a letter from the IRS stating your current non-profit status *

Allowed file types: pdf doc docx.

What year was your non-profit established? *

Address *

Address 2

City *

State *

Zip Code *

Contact Person *

Contact Title

Contact Phone Number *

Contact Email Address *

Does your organization or its parent organization have a religious affiliation? (If yes, fill out Section 3B.) *

Organization's Mission *

Please include confirmation from the Delaware Division of Corporations that your non-profit is still in good standing. If your non-profit is established in another State, please include confirmation that you are in good standing with the application State (confirmation must be within the last two years). *

Allowed file types: pdf doc docx.

List your non-profit's board of directors/officials:

Name 1

Name 2

Name 3

Name 4

Name 5

Name 6

Name 7

Name 8

Name 9

Name 10

If you are required to file a 990, please upload your most recent 990 filed with the IRS.

Allowed file types: pdf doc docx.

If you are not required to file a 990, please upload your last full year's profit and loss, and balance sheet.

Profit and Loss

Allowed file types: pdf doc docx.

Balance Sheet

Allowed file types: pdf doc docx.

Total Funding Request *

Has your organization received other grant funds, not including last year's human service grant, from Sussex County Government in the last year?*

Are you seeking other sources of funding other than Sussex County Council? *

If so, what percentage of the funding of the project will be coming from Sussex County Council? %

Section 2: Program Description

Section 3: Program Scope

A. Briefly describe the program for which funds are being requested. The narrative should include the need or problem to be addressed in relation to the population to be served or the area to benefit.*

B. IF RELIGIOUS AFFILIATION WAS CONFIRMED ABOVE IN SECTION 1, PLEASE FILL OUT THE FOLLOWING SECTION. IF RELIGIOUS AFFILIATION WAS NOT CHECKED IN SECTION 1, THIS SECTION MAY BE LEFT BLANK.

A faith-based nonprofit organization is eligible to receive and apply for a grant on the same basis as other nonprofit organizations, with respect to programs which are eligible. In the selection of grantees, the County will not discriminate for or against an organization on the basis of the organization's religious characterization or affiliation. However, certain requests to utilize funding for programs with religious purposes may not be eligible due to constitutional principles of the United States and/or the State of Delaware.

Briefly describe the components of the program that involve religious purposes and the components that involve secular purposes, or non-religious purposes. If both non-religious and religious purposes are involved in the program, this narrative must include the specific actions that will be implemented in order to ensure that the funding is solely used for non-religious purposes and will not be used to advance or inhibit religious or faith-based activities.

After the awarded funds have been made, receipts of the non-religious purchases shall be submitted in accordance with Section 5 below before funds will be disbursed.

Section 4: Budget

Please enter the current support your organization receives for this project (not entire organization revenue if not applicable to request) * $

EXPENDITURES

Please enter the total projected expenses for the project (not entire organization expense if not applicable to request).

Description:

Construction/Acquisition

Amount $

Other Operating Costs

Amount $

Personnel

Amount $

TOTAL EXPENDITURES $

*TOTAL DEFICIT FOR PROJECT OR ORGANIZATION $

*The project will not be eligible for a grant unless there is a deficit.

Section 5: Statement of Assurances

If this grant application is awarded funding,

Name of Organization *

agrees that:

For non-religious organizations, all expenditures must have adequate documentation and must be expended within one (1) year of receipt of award funds. The funding awarded to the organization must be used in substantial conformity with the anticipated expenditures set forth in the submitted application. All accounting records and supporting documentation shall be available for inspection by Sussex County within thirty (30) days after the organization's expenditure of the awarded funding, or within one year after the receipt of the awarded funds, whichever first occurs.

For religious organizations, all accounting records and supporting documentation shall be provided for inspection by Sussex County after the award has been made by County Council but before the funding is released.

No person, on the basis of race, color, or national origin, should be excluded from participation in, be denied the benefit of, or be otherwise subjected to discrimination under the program or activity funded in whole or in part by these Grant funds.

All information and statements made in this application are accurate and complete to the best of my information and belief.

All funding will benefit only Sussex County residents.

All documents submitted by the applicant are defined as public documents and available for review under the Freedom of Information Act of the State of Delaware.

All funding will be used exclusively for secular purposes, i.e., non-religious purposes and shall not be used to advance or inhibit religious purposes.

In the event that the awarded funding is used in violation of the requirements of this grant, the awarded funding shall be reimbursed to Sussex County within a timeframe designated by Sussex County by written notice.

Applicant/Authorized Official *

Date

Affidavit Acknowledgment *

I acknowledge and represent on behalf of the application organization that I have read and understand the Grant Program Guidelines and Affidavit of Understanding.

Please fill in the required fields