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Step One

Please describe how the grant, if awarded, would be used and how this use relates to any of the award criteria in the Town's Grant to Community Organizations Policy*
Requested Grant Amount*
Has the Town of Severance contributed to the Requesting Organization in the past?*
Select one
1. Yes
2. No
If yes, what amount(s) and when?
If yes to the above, please provide detailed accounting of how the funds were used and describe how the funds benefitted the community (attach documentation if needed)
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List your organization's top five funding sources and amounts that were received from the sources broken down in the last two fiscal years (corporate, government, and/or individual contributions)*
Does the IRS classify you (the requesting organization) as a 501(c)3 organization?*
1. Yes
2. No
3. N/A
Please attach the following information to complete your grant request
1. Along with this application, include a brief description of the requesting organization (including its mission and leadership) and any other information relevant to this request.
2. Most recent year's actual income and expenses for the organization and for the specific event or project for which the funds will be used.
3. Most recent budget for the organization and for the specific event or project for which the funds will be used.
4. Names and addresses of all board members, including designated officers.
5. Any other documents that will support the application.
Requested document upload
Affirmation of Application
By submitting this application, you are certifying that a) the information in the application and supporting documents are correct to the best of your knowledge, and b) the Internal Revenue Service (IRS) 501(c)3 determination, if applicable, has not been revoked, canceled, or modified; and c) funds will be used for the projects outlined in this Community Grant Application.

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