Ideal Community Fund Application

Intrepid Ideal Community Fund Application

Which focus area does your grant project fall into?

Veteran Support Services Children & Family Services Food Banks / Pantries and Food Distribution

Name

POC Email

POC Phone Number

Organization Name

Organization Address

Organization Phone Number

Organization Website

Executive Director

Are the services/benefits you provide in any way based upon a beneficiary’s affiliation with any of the following: (religious, civic, political, tax-supported, labor, fraternal, or educational institution/organization?)

Yes No

Is the organization managed, operated, controlled, or affiliated with one of the following: (religious, civic, political, tax-supported, labor, fraternal, or educational institution/organization?) If so, list below:

Please describe the purpose(s) and major program(s) of your organization in a 100-150 word write-up. Please include, “Who we are and what we do."

Are you a qualified 501(c)(3) as determined by the IRS?

Yes No

Provide a description of the project for which you are requesting funding:

Please provide the total amount requested for your project.

Please provide a full description of your requested grant amount and a breakdown of the use of funds and costs.

Are you willing to accept fewer funds if the total requested is not available?

Yes No

If your organization receives an Intrepid Ideal Community Fund Grant, what is the time frame or schedule to use the funds?

What regional area will be directly served? (i.e. North Alabama residents, Suffolk County, VA, etc.)

Are the services rendered open to all members of the community regardless of sex, gender, race, religion, political affiliation, ability to pay, or background?

Yes No Other

If you answered "Other" please explain below.

All grant recipients are expected to comply with a follow-up report describing the use of funds. This report is expected to be submitted with photo or video evidence that the funds were used for the purpose intended. Is your organization willing to comply with the requirements?

Yes No

If you have links to videos about your organization you can optionally provide those below:

Provide 2-3 individuals outside of your organization who are familiar with your organization and can provide references on your behalf. Include the name, phone, and email of each reference below:

Please include an IRS Determination Letter and IRS Form 990-PF. All financial information will remain confidential within the Intrepid Ideal Community Fund Advisory Committee. Any additional supporting documents (marketing materials, brochures, etc.) can be attached here as well. Please clearly name your files for easy identification.

If an Intrepid employee referred you to our fund, list them below:

By submitting this application, you are certifying that all information on this application is true and accurate, and agree to comply with all requirements of this application.