Community Impact Grant Application

Is your organization an IRS 501(c)(3)?*
- Yes
- No
Is the project/program available to Suffolk/Western Tidewater residents?*
- Yes
- No
Did your organization receive a grant from the Suffolk Foundation last year?
- Yes
- No
Has your organization submitted an interim/final report for last year's grant?
- Yes
- No
We're sorry! You are ineligible for this grant.

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Organization Name*
Tax ID Number*
CEO/Executive Director*
Name and Title
Contact Person*
Name and Title of Point of Contact for this grant application
Contact Person Email*
Email of Point of Contact for this grant application
Has your Organization previously received a Suffolk Foundation grant?*
- Yes
- No

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Brief Proposal Description*
Total Project Budget*
Total Amount Requested*
Total number of individuals to be served by this program*
Number of Suffolk/Western Tidewater residents to be served by this program*
Organization Overview*
Brief description of organization; mission and/or vision statement(s); number and composition of full and part-time staff and volunteers; the population served by the overall organization and the project, including numbers and geographic location
Project Description*
Need for the project; project goals & objectives; collaborative activities; definition of project success; outcomes to be measured, including measurement & evaluation procedures/instruments

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Current Organizational Budget*
Allowed file types: pdf, doc, docx, txt, rtf, jpg, jpeg, gif, tif, tiff, png, wpf, odt, wpd, svg, csv
Accepted file types: pdf, doc, docx, txt, rtf, jpg, jpeg, gif, tif, tiff, png, wpf, odt, wpd, svg, csv.
Project Budget & Amount Requested*
pdf, doc, docx, txt, rtf, jpg, jpeg, gif, tif, tiff, png, wpf, odt, wpd, svg, csv
Accepted file types: pdf, doc, docx, txt, rtf, jpg, jpeg, gif, tif, tiff, png, wpf, odt, wpd, svg, csv.
Project Budget Narrative*
Explanation of line items, if needed, and description of how Suffolk Foundation funds will be used

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For all file uploads below, here are the allowed file types: pdf, doc, docx, txt, rtf, jpg, jpeg, gif, tif, tiff, png, wpf, odt, wpd, svg, csv
IRS 501 (c) (3) Determination Letter*
Accepted file types: pdf, doc, docx, txt, rtf, jpg, jpeg, gif, tif, tiff, png, wpf, odt, wpd, svg, csv.
Most current Audit Report
Accepted file types: pdf, doc, docx, txt, rtf, jpg, jpeg, gif, tif, tiff, png, wpf, odt, wpd, svg, csv.
Most recent IRS Form 990*
Accepted file types: pdf, doc, docx, txt, rtf, jpg, jpeg, gif, tif, tiff, png, wpf, odt, wpd, svg, csv.
Current Financial Statement*
Accepted file types: pdf, doc, docx, txt, rtf, jpg, jpeg, gif, tif, tiff, png, wpf, odt, wpd, svg, csv.
Evidence of Accreditation, Licensing, etc. (if applicable)
Accepted file types: pdf, doc, docx, txt, rtf, jpg, jpeg, gif, tif, tiff, png, wpf, odt, wpd, svg, csv.
Board & Staff Listing*
Accepted file types: pdf, doc, docx, txt, rtf, jpg, jpeg, gif, tif, tiff, png, wpf, odt, wpd, svg, csv.
By checking this box, you agree to the following terms:*
If a grant is awarded, the Non-Profit Organization agrees to provide the Suffolk Foundation with a short description, which may be published, of the way this grant has assisted your organization.
- I agree with the terms
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