Grant Application Note: You will receive a copy of your application via e-mail once you submit this form; please be sure you enter your e-mail and other contact information accurately! Fields with asterisks are required.Name of Organization* Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Person* First Last Title Phone*Email Website Federal Tax Id Attach List of Governing Board, Including Names, Addresses, and TitlesAccepted file types: pdf, doc, docx, xls, xlsx, Max. file size: 32 MB.PART 1 - INFORMATION ABOUT THE APPLICANTIs the applicant currently a 501(c)(3) nonprofit organization recognized by the Internal Revenue Service? Yes No Attach a copy of the IRS exemption letter. (Do NOT attach a copy of your sales tax exemption.)Accepted file types: pdf, doc, docx, xls, xlsx, Max. file size: 32 MB.Explain why applicant could still qualify for funding from this Foundation.Brief Organizational Overview: (include mission statement)*Have funds been requested/funded from other sources for this project?* Yes No If funds have been requested/funded from other sources for this project, please furnish the following:Accepted file types: pdf, doc, docx, xls, xlsx, Max. file size: 32 MB.Amount(s) previously requested Source of request Date of request Date & Amount ReceivedHas the organization previously received funds from The William Stretesky Foundation?* Yes No Please specify amount(s) and years(s) received.Part 2 - Grant RequestTotal Amount of Project*Please do not include $ - just enter a numberTotal Amount Requested From Stretesky Foundation*Please do not include $ - just enter a numberOrganization's Contribution Towards Project (i.e. cash, time, services, etc)*Provide a description of the grant request including the projected immediate outcome:*If this request/project is ongoing, please share the organization’s future financial security plan:Explain how this request/project enhances our community and the impact it will make on Sedgwick County residents:*Is there any other pertinent information you would like to share with the Foundation Board?Please attach your organization’s supporting documents including: most recent financial statement; current year’s budget: multiple estimates for project; and pictures, if applicable. If any of the above is not available, attach a statement of explanation.* Drop files here or Select files Accepted file types: pdf, doc, docx, xls, xlsx, Max. file size: 32 MB, Max. files: 12. * I HEREBY CERTIFY THAT, TO THE BEST OF MY KNOWLEDGE, THE ABOVE INFORMATION IS TRUE AND CORRECT AND THE APPLICANT ORGANIZATION HAS AUTHORIZED ME TO MAKE THIS APPLICATION TO THIS FOUNDATION. THE UNDERSIGNED ALSO ACKNOWLEDGES THAT THE WILLIAM STRETESKY FOUNDATION RESERVES THE RIGHT TO REJECT THE FUNDING OF ANY GRANT APPLICATION IN WHOLE OR IN PART.Authorized Agent’s Signature and Title*
