Community Assistance Grant Application 2016-2017

Fort Leavenworth Spouses’ Club Community Assistance Committee P.O. Box 3004 Fort Leavenworth, KS 66027 www.fortleavenworthspousesclub.org

The Fort Leavenworth Spouses’ Club (FLSC) is proud to give back to the Leavenworth Community. We strongly encourage organizations to apply for FLSC grants and use those funds to support programs in our community. Resources are limited, and many worthy organizations deserve support. If your organization receives grant money from the FLSC, the FLSC requires the funds are utilized only for the purpose described in this application and within two months of the award. We also need your organization to provide documentation (dated receipts and or invoices) and pictures of the purchases (when possible) or a description of how funds were spent.

Please answer all questions on this application. Applicants may handwrite or type the requested information on this form. Please submit your organization’s application via the above address or email to: [email protected] by March 1, 2017.

Community Assistance Grants are on awarded May 1, 2017. Receipt documentation, therefore, must be provided by July 1, 2017.

Name of Organization:______

Tax ID number, if applicable:______

Name of Contact Person:______

Daytime Telephone:______Evening:______

Email:______

Mailing Address:______

______

Check Shall be issued to:______

Address to where check should be sent, if different from above:

______

1 | Page I. Grant Request Details:

Amount of Request:______

Please state the specific purpose of requested funds, to include the amount and purchase price of materials, equipment or services (e.g. replacement of old/broken chairs for youth activities, 15 chairs at cost of $20.00 each, flyer included from School Supplies, Inc.).

______

Note, the FLSC awards funds to support a specific purpose as described in this application. It is important the funds awarded by the FLSC are spent specifically to support the purpose described. Should your organization receive a FLSC Grant, you are required to provide dated receipts or invoices that confirm the funds were spent as described within two months of the award. Any awarded funds remaining after your purchase is complete should be returned to FLSC.

II. Organization Background:

Briefly indicate the purpose of your organization and its benefits to the community as related to the requested funds. Please include how many individuals will directly benefit from the requested funds.

______

Please provide your organization’s demographic served or membership:

Total number of members or people served:______

2 | Page Totally number military/military family members served:______

If there is any other information about your organization that the members of the FLSC Community Assistance Committee should consider, please state here or on an attached separate sheet.

______

III. Organizational Funds:

If you received funds from the FLSC Community Assistance Committee in the past, please note the amount and briefly how the funds were utilized. FLSC Grants may not be requested for items/purposes that have been awarded grants in previous years without providing documentation of on-going need. For example, if more new chairs are needed for youth activities, provide a reason why more chairs are needed.

______

Has your organization raised funds during the period 1 January 2016 to 1 January 2017?

Yes ____ No_____

If yes, please state amount and use: ______

Has your organization requested funds from other sources? If so, list sources:

______

3 | Page ______

IV. Official Fort Leavenworth Activities and Agencies Only:

1. Is this organization a government funded agency?

Yes ____ No______

If yes, has this request been approved by the Garrison Commander?

Yes____ No______

Please provide letter of approval with this application.

2. Are you authorized appropriated funds for the purpose of this request?

Yes____ No______

3. Are you authorized non-appropriated funds for the purpose of this request?

Yes____ No______

If you answered yes to either questions 2 or 3 above, please explain why such funds are insufficient for this purpose.

______

4 | Page I. Summary of Key Points:

1. Applications must be submitted in full by March 1, 2017.

2. Ensure an official representative of your organization signs the application.

3. Note that any awarded funds are to be spent to fulfill the purpose described in this application.

4. Awarded funds that are not spent in support of the purpose described in this application must be returned to the FLSC no later than July 1, 2017.

5. Community Assistance Grants checks must be cashed by July, 11 2016. They will be voided after that date.

6. Dated receipts and/or invoices that indicate your organization has expended awarded funds in support of the purpose described in this application must be provided to the FLSC by July 1, 2017.

7. Your organization agrees to acknowledge the receipt of the FLSC Community Assistance Funds in a method that your organization deems appropriate. If your organization would like a plaque that states, “Donated by the Fort Leavenworth Spouses’ Club 2016-2017”, to acknowledge an item bought with donated money, the plaque will be provided by the FLSC upon request.

8. Section IV and an approval letter from the Garrison Commander (when applicable) must be completed for official Fort Leavenworth activities and agencies.

An official representative of your organization must sign this request. The signature certifies your understanding of the application instructions, FLSC Grant guidelines, and allows the FLSC to use your organization name for public recognition.

Signature______Date______

______

For FLSC use:

Date Received:

Amount Awarded:

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