Grant Application

  

                   

WOMEN of Southwestern Pennsylvania, Inc. is a non-profit, tax exempt 501(c)(3) organization, based in the South Hills of Pittsburgh, dedicated to directly supporting less fortunate women and families in Allegheny, Washington, Greene and Fayette counties.

Date of Application:  __________________________

ORGANIZATION AND CONTACT INFORMATION:

Organization Name: _________________________________________________________________

Organization Address: _________________________________________________________________

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Executive Director: _________________________________________________________________

Contact Person & Title: _________________________________________________________________

Contact Person Phone:  _________________________________________________________________

Contact Person Email: _________________________________________________________________

Organization’s Website: _________________________________________________________________

GRANT REQUEST INFORMATION: An Organization may request up to $2,500. Grants may be awarded in lesser amounts.

Amount Requested:  _________________________

Total Project Budget:  _________________________

Percentage of Total Project Budget: _________________________

Organization’s Total Operating Budget: _________________________

Type of Request:  ___ Program ___Supplies ___ Equipment  ___ Other (Explain)

County(ies) where service is provided: ____________________________________________________

GRANT REQUEST SUMMARY: Include an itemized list specifying how the grant funds will be allocated for programming and services.

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REQUIRED ACCOMPANYING DOCUMENTS:

___ Cover letter describing your organization, programs and services offered and how your organization impacts the community.

___ Current copy of 501(c)(3) designation by Internal Revenue Service indicating that your organization is a public charity.

___ List of Board of Directors ___ Organizational Chart

I CERTIFY, TO THE BEST OF MY KNOWLEDGE, THAT:

1. The Organization does not support or engage in any terrorist activity, and

2. If a grant is awarded to the Organization, the proceeds of that grant will not be distributed to or used to benefit any organization or individual supporting or engaged in terrorism, or used for any other unlawful purpose.

SIGNATURES:

President, Board of Directors: ___________________________________________________________

Executive Director: ___________________________________________________________

PLEASE SUBMIT A HARD COPY TO:

WOMEN OF SWPA

PO BOX 1112

MCMURRAY, PA 15317