Please use 8 �" x 11" paper using the number and letter sequence shown below for identification purposes. Each copy of Items 1-10 are to be paper clipped together (no staples). Please do not bind copies or put into folders. If a question is not applicable to your grant request, please list the number of the question and state "NA".

ITEMS 1-10 (Eleven [11] copies)

ITEMS 11-20 (One [1] copy)

Legal name of organization (name on IRS exemption letter)
Physical address and mailing address
Contact person, title (including e-mail address, if available)
Telephone number
Fax number and website address
Amount of money requested for this grant application and total cost of the project
Using no more than three (3) sentences, describe how grant funds will be used
Mission of organization, primary goals, and recent major accomplishments of the organization.
Project description (description must, at a minimum, address the following):

Number of clients to be served by this grant

The community need met by the proposal

What other local agencies or services address the same problem(s) and how they do so�a statement of how your approach differs from or augments these services

Plan for output measurement: the direct product of program operation (e.g. # of classes taught, # of participants served)

Plan for outcomes measurement: the benefit to participants during or after participating in the program

A timetable and/or work plan for the project

If your project/program will cost more than you are requesting from us, indicate how you will fund the balance. Show any in-kind support, other grants applied for and/or funds already received on your project budget.

If the program is ongoing, indicate a plan for continuing to fund the project after the initial grant period is over.

A line item budget for the project in which you are applying. Include both revenue and expenses (sample format attached and on website)

If applicable, letters of agreement from collaborating organization(s).
Quotations from three separate sources for any individual item or system over $1,000 requested in the grant and outlined in the budget
Amount of your agency�s endowment, if any; AND amount of endowment of affiliated organization and/or foundation, if any
Where applicable, the percent of your annual budget that goes to your national affiliate. Will any percent of THIS grant go to your national affiliate?
A copy of your organization�s audit or statement of income and expenses for the previous two years AND most recent 990 if applicable
Current annual agency budget with year to date actual and variances (revenue and expenses). Include next year�s budget if available.
A copy of the organization�s most recent 501(c)(3) determination letter, which is the IRS letter of exemption from federal income tax (not state sales tax exemption certificate) or other proof of federal tax-exempt status
A list of the Board of Directors, their addresses and occupations
A letter signed by the President/ Chairman of the Board authorizing submission of the proposal
Name of trustee sponsoring application

For printable budget forms, download the attached forms in PDF format

Sample Capital Budget Sample Program Budget

Download Adobe
Acrobat Reader

A final report of grant expenditure must be completed and returned to the The Goldsmith-Greenfield Foundation office as soon as all funds have been expended or by <due date will be inserted here>, whichever comes first. If the organization wishes to extend the grant period, it must secure permissions to do so by writing to the Foundation at the address below.

Organization

For prior grant history click here

GUIDELINES FOR GRANT PROPOSALS

ITEMS 11-20 (One [1] copy)