Grant Application Form I. Organization InformationName of Organization*Contact Person & Title*Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Phone*FaxEmail* EFIN#*Website Have you ever been funded by the Snowshoe Foundation?*YesNoHow much did you receive from the Snowshoe Foundation?*Briefly describe the project*Note: If you are a School (or school related) applying for a grant – please skip questions 1 – 3Provide a brief narrative of the organization to include: (a). Mission & Purpose, (b.) Year organization started, (c.) Services provided, (d.) Geographic area servedDescribe the revenues your organization receives from all sources and indicate how it is used to support your program or need:Organization’s current annual operating budget:Have you applied for funding from other sources for this same project? If so, how much funding was requested and when will you know if funding was approved? (Please keep us updated as you are informed)*II. Project InformationName of Project*Amount Being Requested*Time Frame for Project*Project Class*HealthHuman ServicesEducation/ArtsRecreationCultureEnvironment1. Please provide a brief outline of the goals and objectives for this project:*2. Provide a complete detailed project budget that lists all expenses and each source of income, to include the amount requested from the Snowshoe Foundation.*a. Examples of expenses: Equipment, Materials, Personnel, Consultants, etc… (note: the Snowshoe Foundation does not fund salaries, compensation, ongoing costs) b. Examples of income: In kind support, Snowshoe Foundation, Individual Contributions, Business Sponsorships, Other Funding3. Sustainability Plan: Describe how the project will be financially and organizationally sustained at the end of the grant.*What would it mean to you or your organization if funding is not/or only partially provided by the Snowshoe Foundation? What other options would you pursue?*5. Please describe any partnership that you have entered into with the Snowshoe Foundation (Have you volunteered for an event, sold Treasure on the Mountain Raffle tickets, etc)?*If you have any additional information or comments, please provide here:1. A copy of the most recent Audited Financial Statement. If there is not an Audited Financial Statement, please explain and attach a copy of the most recent 990. Please note, if you have the 990 postcard, attach a copy of the postcard and a completed Fiscal Year Financial Statement.2. A list of the names, titles, and city or town of residence for the board of directors, chief executive officer, and any other key personnel or volunteers involved in the project. The deadline for submitting grant applications has passed.