Name of Organization
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Person Submitting Application
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First Name
Last Name
Address of Organization
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Telephone of Organization
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(###)
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Name of President, Chief Executive Officer or other official responsible for information contained in this application.
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First Name
Last Name
Briefly state the purpose for which funding is being requested.
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If the applying agency has previously received a grant from the JCBF in the last three years, please state the amount(s) received and provide any available documentation demonstrating that those funds were used consistently with the purpose of the request in any given year.
Describe the organization, the date organized, the history of the organization and the purpose of the organization’s existence.
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Describe the project/program to be funded, as listed in paragraph five (5) on the attached application, more fully.
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Describe the geographical area to be served should this organization receive JCBF funding.
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Identify other organizations or services which provide similar services in the same geographical area referenced in paragraph ten (10) above. Describe any cooperative work between this organization and any other agencies/organizations referenced as an answer to this question.
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State other ways your organization uses volunteers or obtains donated goods or matching funds to further facilitate the purpose of this grant request.
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Describe how the organization will measure the effectiveness of the program or project for which funds are being sought.
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Is the financial viability of this program contingent upon receipt of JCBF funds?
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State other sources of funding being sought to support the purpose of this grant request, as well as ways in which this organization will be funding this project or program in the future. Further, please state the estimated cost to the organization for this project/program for the year that funding is being sought.
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Please state any other reason, or provide any additional relevant information in support of this organization receiving JCBF funding.
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By signature below, the authorized representative of this organization seeking JCBF funds through this grant process acknowledges that they have received a copy of the “Grant Policies & Guidelines” prepared by the Johnson County Bar Foundation. Signature below represents that this authorized representative has either personally prepared, or reviewed and approved, the information contained within this application and affirms that all information contained herein is accurate, is being provided solely for the purposes of obtaining funding for a purpose set forth in paragraph five (5) above, and that such representative shall be responsible for assuring compliance with JCBF Grant Policies and Guidelines.
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First Name
Last Name
I plan to email additional files.
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