MLKCC Community Grants Application Form

Grant Application Disclaimer:

Thank you for your interest in our grants program. Saving your progress will store a copy of your entry on this server and the site owner(s) may have access to it. For security reasons, sensitive information such as mailing addresses, along with file uploads, will have to be re-entered when you resume.

Organization Name *

Name of Person Submitting Application *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Website

Are you submitting a joint application with a second organization or do you have a fiscal agent? *

If yes, please please list their name, title, and contact information below.

Name of joint applicant or fiscal agent

Title (if applicable)

Phone

NONPROFIT STATUS

If your organization is 501(c) (3)-exempt, then please provide your Tax ID Number

PROJECT DESCRIPTION

Project Name *

Grant Amount Requested *

Briefly summarize the program or project for which you are requesting these funds - Purpose of the project (email additional documentation as needed). *

Your goals & objectives (email additional documentation, as needed). *

Potential Project Activities (email additional documentation, as needed). *

Describe how you will measure outcomes and impact (email additional documentation, as needed). *

Projected Start Date of Project / Program *

Projected Date of Project Completion *

Approximately how many people will this program or project impact? *

What are your organization’s priorities as they concern this project or these projects? (email additional documentation, as needed). *

What is your marketing plan for the project(s)? (email additional documentation, as needed). *

What is your fundraising plan for this project? (email additional documentation, as needed).

Any additional information that you would like to share with us? (email additional documentation, as needed).

BUDGET AND BUDGET JUSTIFICATION

Attach a detailed budget for the proposed project/program below. If this project will be partially funded by sources other than those additional funds (i.e. have they been awarded, have they been applied for, etc.). Please include other funding sources in proposed budget when applicable. Additional information may be requested by the Grant Screening Committee if these items are included in the grant request. *

Click or drag files to this area to upload. You can upload up to 5 files.

Total Project Budget *

ADDITIONAL MATERIAL (OPTIONAL)

If desired, you may also submit copies of supporting materials specific to this grant application such as supporting letters from other agencies or persons, or resumes of project personnel. Please email supporting materials to: grants@mlkcc.org

Click or drag files to this area to upload. You can upload up to 10 files.

REQUIRED PROJECT UPDATES

If your proposal is approved, you will be required to provide quarterly (every 3 months) updates (including narratives, photos, and videos) on status of your project. A brief final report also will be required where you summarize the accomplishments of your work and its impact on the communities that you support. You may email these documents to: grants@mlkcc.org

ACKNOWLEDGEMENT

Check the box below *

I agree to provide required project updates/progress, photographs, and to provide permission for the use of any photographic images in any media campaigns.