Questions to consider and summary of information you will need to provide in completing the 2018 North Shore Exchange Grant Application
In addition to the information already submitted with the Letter of Inquiry, below is a detailed summary of the information you will be asked to supply on the Grant Application. A list of financial documents you must upload when submitting your Grant Application is also provided on the last page of this document. Please review the information below in detail before beginning your application.
- Organization Name
- Contact Information: Name, title, phone number, and email
- Alternate Contact: Name, phone number, and email
- Year Founded
- Provide mission statement, a brief history of your organization and summary of the primary program in support of your mission.
- Specify type of NSE grant requesting and amount
- Program/Project name
- (Following Applicable Program/Project Questions)
- Amount Requesting
- Total number served by organization in 2017
- Describe the program, project or purpose for which you are requesting the grant.
- Describe the target population you expect to serve through this particular program/project.
- Number served in the program/project for which you are requesting the funding.
- State need for services and/or project/program and provide evidence of that need and how the services will be implemented.
- Provide quantitative data or results measuring the impact of services on your served population.
- Describe other funding sources for this program/project. If the program/project is collaborative, provide specifics and list all partners.
- Describe plans for the program/project sustainability. What are future funding plans? If support is insufficient to meet the budgeted expenses, indicate how the deficit will be met.
- Provide relevant program/project start and end dates along with any other significant project dates.
- What additional information about your organization or program/project would you like to share with us?
In completing the financial summary, provide information from your organization's most recent financial records; two years of historical documented data and one year of forecasted data. Financial information should come from your organization's IRS Form 990, Form AG-990-IL and/or Annual Report.
- Current Fiscal Year Ending Date; Month, Date and Year.
- Public Support, Contributions, and Program Service Revenue
- Government Grants and Membership Dues
- Other Revenues
- Revenues from Fundraising Events
- Total Revenues, Income, and Contributions Received
- Total Charitable Program Service Expenses
- Management and General Expenses
- Executive Director Salary
- Fundraising Expenses
- Compensation to the (3) Highest Paid Persons; Name, Title, and Salary; current fiscal year and previous fiscal year.
Assets and Liabilities; Fiscal Years 2016, 2017 and forecasted 2018
Program/project Budget: Revenues and Expenses for Fiscal Years 2016, 2017, and forecasted for 2018
Top 5 Organization Funding Sources and amounts for Current Year, Previous Year and pending current Fiscal Year. Name, amount and date requested.
- Does your organization have an endowment? If so, what is its value? What percentage of the principle and/or earnings, go to general operations on an annual basis?
Organization Background and Administrative Information
- Provide the following personnel composition numbers: Total Staff, Full Time and Part Time, Senior Management, Volunteers and Board Members.
- Do you conduct a review or evaluation of your Executive Director? If yes, how often is the review completed and what is the method of evaluation?
- Describe the qualifications/bios of key staff.
- Is there litigation pending or threatened against your organization or leadership?
- Was a lawsuit settled in the past 5 years and if so how much was the settlement?
- Does your organization carry a general liability and D& O insurance and how much coverage for each type?
- Does your organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If yes, describe.
Please attach copies of the following documents:
- IRS charitable status determination letter
- Most recent IRS 990 form and prior year
- Most recent AG990 - IL and prior year
- Most recent audited financial statement and prior year
- Current fiscal year budget, actuals and projected
- Most recent Annual Report
- List of Board Members/Bios
Last Updated 2018