Grant Application

General Information

Name of Organization*

Federal Tax Identification Number*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Website

Primary Contact*

First Last

Title*

Phone*

Email*

Grant Request

Grant amount requested*

Purpose of Grant*

Operating
Program/Project
Other

What is the purpose?

Describe the Purpose for which the Organization seeks support:*

How will Grant effectiveness be measured?*

Will Grant address one or more of the following Exchange Club funding priorities?*

Child Abuse Prevention
Education
Youth Programs
Americanism

Please check all that apply.

Are matching funds available?*

Yes
No

Please identify each source*

Requested Attachments

Please include each of the following.

Cover Letter

Max. file size: 50 MB.

Current IRS determination letter indicating tax exempt 501(c)(3) status

Max. file size: 50 MB.

Board of Directors list, including names and affiliations

Max. file size: 50 MB.

Current IRS Form 990

Max. file size: 50 MB.

Authorization

The undersigned certifies that the undersigned is authorized to represent the Organization applying for a Grant, and that the information contained in this Application is accurate. The undersigned agrees that if the Grant is awarded to the Organization: (1) the Grant will be used for the purpose outlined in the Grant Award Letter from the Exchange Club of Newport Harbor, and may not be expended for any other purpose without prior written approval from the Exchange Club of Newport Harbor, (2) the Exchange Club of Newport Harbor has received nothing of material value in exchange for the Grant, and (3) information about the Organization and the Grant may be used by the Exchange Club of Newport Harbor in any published materials.

Signature*

Date*

Title*

Consent*

I Accept

By selecting the "I Accept" button, you are signing this document electronically. You agree your electronic
signature is the legal equivalent of your manual/handwritten signature on this document.

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Comments

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Community

Does your organization Do Work that Aligns with Our Mission?

We Offer Grants to organizations that do work that supports the mission of the exchange club. Complete the form Below or Download A Copy

and Return.