- Name of Organization:__________________________________
(Eligible organizations are those classified as 501(c)(3) by the Internal Revenue Service or tax-exempt educational organizations. For this grant application, tax-exempt educational organizations are defined as public schools and charter schools. Private schools and home-schooled individuals are eligible to be recipients of funds from OCBA, but please be aware these funds may be treated as taxable income and the recipient should consult their own tax advisor as to the tax consequences before accepting any funds.)
- Contact Information:
Contact Person__________________________________________________________
Email__________________________________________________________________
Phone__________________________________________________________________
Address_________________________________________________________________________________________________________________________________________
- Requestor’s Mission Statement or Statement of Purpose:
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
- Briefly describe your project for which funding is being requested. Tell us why you want funding, how it will benefit our community and what you hope to accomplish:
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
- Tell us about yourself, including what skills, qualifications, and experiences you have for implementing and maintaining a successful project:
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
- What is new or innovative about your project? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
- What research have you done to determine if this project will work? Why do you believe this project can be successful?
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
- What is your goal for the project? Who are the beneficiaries of this project?
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
- Describe in detail your plan for completing your project. Tell us the specific tasks to be completed. Assuming your project will be fully funded, give dates by which you will complete them.
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
- Are you receiving funds from other sources? If yes, please note the sources and approximate amounts. How much money are you/your organization personally investing in this project?
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
- How will the project be maintained after completion, if applicable?
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
- Attach a copy of your organization’s most recently available financial statement and budget, if applicable.
- If applicable, has your governing board or chief executive specifically endorsed this project and authorized you to submit this grant application for funding?
Yes______ No_____
- I have reviewed the Grant Agreement and am comfortable with its requirements should I receive a grant.
Yes______ No_____
SIGNATURES
Thank you for completing the grant application form. By signing this document, you are certifying that the information contained in this Grant Application is true and correct to the best of your knowledge. You acknowledge your intent and request for OCBA grant funds to be used for the above-described project in Orange County, NC. You also acknowledge if funded, you will use the money for the purposes set forth in this application.
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Signature (Primary Applicant) Date
________________________________ _________
Signature (Secondary Applicant) Date
________________________________ _________
Signature (Tertiary Applicant) Date
Submit your completed application by email (PresVP@theocba.org) or mail (The OCBA; PO Box 683; Hillsborough, NC 27278) or in person at an OCBA Meeting.