Community Grant Application – Keta Legacy Foundation

If you think your project falls within our guidelines, please complete the application form below. Most fields are required: we do not accept incomplete applications.

Please note that many mobile devices do not permit file uploads: you will need a computer to complete your grant application.

Applicant*

(Organization or Individual)

Is your organization Federally registered as a nonprofit?*

U.S. Federal Tax ID or Canadian Nonprofit ID (optional)

Contact Name*

The person we should contact with respect to this application.

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Fax (optional)

Email*

Website (optional)

Project Lead*

Please enter the name of the person who will be running the project.

Brief Project Description*

Please provide a concise (2-4 sentence) description of the project and what the grant money will support.

Mission Statement*

Please provide your organization's mission statement.

Narrative*

Upload a short (4-page maximum) narrative telling us about:

• exactly what you propose to do; why it is important; how it addresses the Foundation's priorities; what outcomes you expect to achieve
• who will do the work; include either resumes or short narrative descriptions of qualifications
• a project schedule, including regular progress reports to the Keta Legacy Foundation

Accepted file types: pdf, doc, docx, Max. file size: 256 MB.

Total Project Cost*

Please enter the total cost of your project as a number rounded to the nearest dollar without a dollar sign, i.e. $100,000.15 enter as 100,000

Amount Requested*

Please enter the amount of your request as a number rounded to the nearest dollar without a dollar sign, i.e. $100,000.15 enter as 100,000

Percentage of Total*

Please enter a value between 1 and 100.

Enter up to a 3 digit number representing the percentage of the total project cost you are requesting us to fund, rounded to the nearest whole percentage.

Overhead costs*

Please provide a statement of who will pay the overhead costs of this project.

Applied to other sources?*

Have you applied elsewhere for funds for your project?

Yes
No

Received funds from other sources?*

Have you been awarded funds form other organizations for this project?

Yes
No

If not funded?*

Please write a brief explanation of what you will do if you don't receive the total amount requested.

Acknowledgment*

How will the Keta Legacy Foundation be acknowledged? We expect public acknowledgment of our grant. How and when will you do this?

(Please note that the Mountaineers Foundation is doing business as Keta Legacy Foundation. We are NOT the same organization as The Mountaineers Club)

Financial Statement*

Upload your organization's most recent financial statement. (Please DO NOT send IRS filings or audit reports.)

Accepted file types: pdf, doc, docx, xls, xlsx, Max. file size: 256 MB.

Project Budget*

Upload a specific detailed budget for this project, including cash flow, which shows how the Keta Legacy Foundation funds, and the funds you have requested from others, will be spent.

Accepted file types: pdf, xls, xlsx, doc, docx, Max. file size: 256 MB.

Letter of Support (optional)

Evidence (e.g., a letter) of commitment from any organization you have included in your project's work scope. (Optional)

Accepted file types: pdf, doc, docx, Max. file size: 256 MB.

Nonprofit determination letter (optional)

If you are a Federally recognized non-profit, please upload a PDF copy of your nonprofit letter of determination.

Accepted file types: pdf, Max. file size: 256 MB.

Name

This field is for validation purposes and should be left unchanged.