Antioch Community 2023-2024 Grant Cycle Application

This application form can be used for both the Program/Event Grant and the Community Impact Grant.

Applications may be submitted to the Antioch Community Foundation using the below online form. The deadline for receipt of applications is 5:00 PM, May 26th, 2023. No mailed or faxed documents will be accepted. For questions regarding the Antioch Community Foundation and the application/award process, please send an email to grants@acfcommunityimpact.org.

Please do not close this page before completing and submitting your application, as the information will be lost.

Select Grant(Required)

Program/Event Grant

Community Impact Grant

I am applying for both Grants

Note: Changing the type of grant may delete information in the grant section of the form. We therefore recommend you decide which grant you’re applying for before proceeding past the General Organizational Information portion of this form.

General Organizational Information

Name of Organization(Required)

Contact Completing Application

Name(Required)

First Middle Last

Title

Email(Required)

Phone(Required)

Executive Director or Chief Officer

Name(Required)

First Middle Last

Title(Required)

Organization Information

Primary Address(Required)

Address Line 1 Address Line 2 City State ZIP Code

Do you have a different mailing address?(Required)

Mailing Address(Required)

Address Line 1 Address Line 2 City State ZIP Code

Primary Phone(Required)

Website Url

Facebook Page Url

Is your organization a non-profit (501c3)?(Required)

Please Enter Your EIN Number(Required)

Does your organization have a Fiscal Agent?(Required)

Fiscal Agent Organization Name(Required)

Fiscal Agent EIN(Required)

List the names of Board Officers (with title) and all Board Members of your organization or Fiscal Agent.(Required)

Full Name

Title

Note: If you have a Fiscal Agent, list the names of the local Board or individuals responsible for the project.

Geographical Area Served: Check One(Required)

Antioch only

Antioch and other areas

List Cities/Areas Served(Required)

Describe how you will acknowledge the Youth of Promise Fund and the support of the Antioch Community Foundation. (e.g., in program material, social media, press, event announcements, etc.)(Required)

Is your organization able to provide ACF with photos, video testimonials, and/or other media from ACF supported events(Required)

Your organization will have an opportunity to approve any content used by ACF and contributing content is not a requirement to receive a grant.

Briefly state the mission/purpose of your organization and include a description of the populations you serve(Required)

Program/Event Grant

The Program/Event Grant will provide funds of between $100 and $1,000 for community event sponsorships, program support, and organizational capacity building (such as, office technology, financial management or evaluation/assessment tools, and/or board or volunteer training, etc.) to nonprofit organizations serving one or more ACF grant priority areas.

Name or Title of Program/Event project to be funded(Required)

Enter the amount you are requesting for this project (max $100 – $1000)(Required)

Please enter a number from 100 to 1000.

What is your total project budget?(Required)

Are other funders involved in the project?(Required)

List funders and confirmed and/or pending amounts.(Required)

Funders

Amounts

Briefly describe how these funds will support your effort in roughly 300 words or less. Include your overall purpose/goals; the ACF priority focus area you will serve (Youth Services, Economic Security and Health, and/or Community Services); the event or activity start date and duration; the target population(s) served; projected numbers to be served; the projected benefits to the community or clients served; and your approach or strategy for reaching your desired outcomes.(Required)

Community Impact Grant

The Community Impact Grant will provide funds in the general range of $1,000 to $2,500 with the focus on encouraging outcome-based, collaborative efforts for community impact to nonprofit organizations serving one or more ACF grant priority areas.

Annual organizational budget(Required)

Number of clients served per year

Name or Title of the Community project to be funded(Required)

Amount requesting ($1,000 – $2,500)(Required)

Please enter a number from 1000 to 2500.

Total project budget(Required)

Are other collaborative partners involved in the project?(Required)

List partners and role with project(Required)

Partner Name

Role

Use the plus sign to add more partners

Are other funders involved in the project?(Required)

List funders and confirmed and/or pending amounts.(Required)

Funders

Amount

Use the plus sign to add more partners

Briefly describe how these funds will support your outcome-based and/or collaborative effort for community impact in roughly 500 words or less. Include your overall purpose/goals; the need and ACF priority focus area you are addressing (Youth Services, Economic Security and Health, and/or Community Services); your approach or strategy for addressing the need; the start date, duration, and end date of the project; target population(s) to be served; projected numbers to be served; projected outcomes/impact; and how outcomes/impact will be measured.(Required)

Antioch Community 2023-2024 Grant Cycle Application

General Organizational Information

Contact Completing Application

Executive Director or Chief Officer

Organization Information

Program/Event Grant

Community Impact Grant

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