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COMMUNITY SUPPORT REQUEST FORM

COMMUNITY SUPPORT REQUEST FORM


The deadline for submittal is 5pm on March 15 of each year. If activity is between January 1 and March 31 than application must be submitted by November 15 of the prior year.


Part I: Organization Information

Name of Organization:

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Mailing Address:

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City:

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State:

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Zip/Postal Code:

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Phone Number:

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Fax Number:

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Website:

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Head of Organization or Primary Contact:

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Title:

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Primary Contact Phone Number:

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Primary Contact Fax Number:

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Primary Contact Email: *

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Who currently serves on your organization’s board?

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What is the mission of your organization?

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How would you describe your current constituencies?

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What was your organization’s total annual budget in the last completed fiscal year?

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How many people did your organization serve last year?

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How many full-time employees does your organization employ?

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Is your organization a 501c(3) public charity?

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What is your organization’s Employer Identification Number (EIN)?

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What year was your organization founded?

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Did your organization have a financial audit conducted in the last fiscal year?

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On what date did your organization’s last fiscal year end?

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List any previous support your organization has received from Best Cleaners within the last five years. Provide your answer in the following format: Grant Year & Project Name, Grant Dollar Amount (e.g., 2010 Gift Certificate, $XX,XXX).

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Part II: Grant Request Information

Project/Program Title:

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Project/Program Date:

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Project Description: (Briefly describe the purpose of the project or program. What issues or needs will it help your organization address? What specific outcomes do you plan to achieve with this project? Please limit your response to 1,000 characters including spaces.)

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What amount of funding are you requesting from Best Cleaners?

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Will an auction item such as a Gift Certificate\Gift Bag be useful?

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Is the purchase of an ad and option?

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Use of Funds: (How will the requested funds be used in the project? Be specific. Tell us what would be purchased or funded in terms of tangible goods and/or services. Please limit your response to 500 characters including spaces.)

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Geographic Area Impacted by Project: (mark all that apply)




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Which of Best Cleaners’ priority funding issues most closely aligns with the intent of this project/program proposal? (mark all that apply)





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How many people do you estimate this project/program will serve?

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How would you describe the specific constituency this grant is designed to affect?

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What is the total estimated budget/annual cost of this specific project or program?

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How much money has been raised to date for this project?

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Is the organization\applicant or any of its members a patron of Best Cleaners?

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if so, please specify the name(s) of the patron(s)

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Comments:

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If request is granted our representative will contact the Head of Organization or Primary Contact named above via email (please do not contact us regarding the process and\or results).
Your effort and support of our community is a value we share. We look forward to learning more about your organization and its advocacy.
Thank You,
Best Cleaners




 
 
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