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Livingston Township Municipal Alliance Committee
Funding
Application
(For
Funding Year: January 1, 2007 to
December 31, 2007)
Cover
Sheet
(Please
feel free to generate this cover sheet on your computer)
Name
of organization:_____________________________________________________
_______________________________________________________________________
Telephone:
_________________ Fax: ________________ E-Mail:_________________
Contact
Person: __________________________________________________________
(Organizations
may submit funding requests for different programs and projects by completing
the attached application for each proposal)
2007 Funding Application
Page 2
Program/Project
Funding Application
(Please
complete for each Program/Project where funding is requested)
Name
of organization: ______________________________________________________
Name
of program/project: ___________________________________________________
Contact
person and title:____________________________________________________
Dates
covered by program/project budget (month/day/year): _______________________
Time
line/schedule _______________________________________
Total
program/project budget (for current year): $________________________________
Amount of Funding Requested from LMAC for this Program: $______________________
Total amount required $____________ Breakdown by
categories:
outside consultants $_________
rent $___________
supplies $_________
printing $___________
postage
$_________ phone $___________
equipment
$_________ travel $___________
other
direct costs
$_________
Other
funding sources available or being sought?_______________________________
Please
list name and amount of funding requested from other agencies:
$____________
Can
this program be self-sustaining?_____________________________
If
funds are not available at this time, can schedule be adjusted?_______________
Is
this a new program or an existing program that you want to expand?__________
Target
population _______________________________________
Number
of people to be served _____________________________
Breakdown of participants
____pre-school (0-5)
____elementary (gradesK-5) ____middle
school (grades 6-8)
____high school (grades
9-12) _____adults
Breakdown
of volunteers
____high
school ____adults
What
is the unit of service that applies to this program?. . .
_____
number of sessions _____hours of
session
How
often does the program meet (weekly, monthly, etc)?______________
2007 Funding Application
Page 3
(Three
pages maximum)
Please describe the program/project for
which you seek funding, including:
_____ •
A statement of its primary purpose and the need or problem that you are
seeking to address.
_____
• The population that you serve and
how this population benefits from the program/project.
_____
• Strategies employed to implement
the program/project, including goals and objectives.
_____ •
The staffing pattern for the program/project.
_____ •
Anticipated length of the program/project .
How
will you measure the effectiveness of your Program/Project?
What are the program’s objectives?
(Methods to measure program successes
should include activities such as client satisfaction surveys, staff reports,
records indicating attendance, participation, follow-up, etc.)
Minimum of at least of satisfaction survey must be submitted.
.
(If
more space is needed, please continue on additional sheet)
CEO/Executive Director’s Signature____________________________
Date ________
Funding Committee recommendation ___________________________________
2007 Funding Application
Page 4
Publicity
For the program/project you are requesting funding for:
•
If you received funding last year. please include samples of any
publicity that
illustrates support from LMAC.
•
If funding is approved for the coming year, please indicate how you will
publicize LMAC support.
For the program/project you are requesting funding for:
•
Aligned side by side on the same page, your EXPENSE
BUDGET for the proposed
and most recent fiscal year.
•
Aligned side by side on the same page, a LIST OF ALL OTHER SOURCES of
income, with amounts, for your proposal.
•
Please list the foundations, corporations, and other sources that you are
SOLICITING FOR FUNDING and, to the best of your knowledge, the STATUS OF
YOUR PROPOSAL with each.
Due by April 1, 2006
to Jane Hecht, 2 Emerson Drive, Livingston, NJ 07039.
Please submit TWO
SETS.
Please attach PROJECT
PROPOSAL FORM that includes a breakdown of your budget request by categories.
