Youth Advisory Council Grant Application

INSTRUCTIONS: Please thoroughly answer all questions in the order provided. Representatives of the applicant organization or project team may be asked to send further information or be interviewed by YAC members. Application must be completed by the youth project leader. If the youth is unable to complete the application, please contact the YAC advisor to discuss possible alternatives. Please refer questions to Sam Waller or Duska Brumm at the Barry Community Foundation office: (269) 945-0526.
For NON-PROFIT ORGANIZATIONS: after the application is submitted we will need a copy of IRS Tax Exempt letter confirming 501(c)(3) status and a copy of the most recent annual financial statement and balance sheet.
FOR STUDENT ORGANIZATIONS: after submitting the application, we will need a copy of the organization's constitution, bylaws, rules of procedure, or other proof of organizational structure, and statement of organization's current financial balance signed by an officer.
THESE SHALL BE EMAILED TO: Sam Waller at sam@barrycf.org or Duska Brumm at duska@barrycf.org

Date of Application Date of Application / MM / DD YYYY
Amount Requested:
501(c)(3) non profit tax ID number
Name of Organization:
Name of School (if needed):
Youth Project Leader Name:
Applicant Organization Address Applicant Organization Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone
Email
Adult Sponsor Name (and title if applicable):
Address (if different from organization address: Address (if different from organization address:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone:
Email
HISTORY OF APPLICANT ORGANIZATION
Briefly describe the history of the applicant organization: when it was founded, where it is located, whom it serves and the number of members.
PROJECT TEAM
Please list the number of persons involved in planning the program. Please indicate those who are under 21 and give their ages. List the number and responsibilities of paid staff, if any, and volunteers who will be involved in the project, as well as any other organizations that will assist in the project.
PROGRAM DESCRIPTION
Describe the purpose of your project, the manner in which it will be carried out, how often it will be provided, how many people will be served, and the location where the program is to be provided. Please specifically explain how your project will serve youth, or how it fills the needs of youth in Barry County.
EVALUATION
Please describe how you will determine whether you accomplished your purpose. Please note that if a grant is awarded, it will be necessary to submit a final report to the Barry Community Foundation upon the completion of the grant period, and a site visit to see the completed project may be requested.
PROJECT BUDGET
Please present a detailed estimate of project costs. If transportation costs are included, please attach evidence of current insurance. If project costs exceed your grant request, indicate the source(s) of other funds. State whether this program will continue in the future, and, if so, how it will be funded.
Signature of student filling out application
Certification: To the best of my knowledge and belief, statements in the application are true and correct; the document has been duly authorized by the governing body of the applicant; and the applicant organization will comply with applicable laws, regulations, terms, and conditions in effect at the time of the grant. I understand that the Barry Community Foundation, in evaluating this grant application, may, if it deems appropriate, review any and all of the information submitted as part of this requet with advisors of the Foundation's choosing.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Printed Name:
Date of Signature Date of Signature / MM / DD YYYY
Signature of Teacher/Advisor
In signing this application, the adult advisor/director verifies that the applicant is a registered student organization and that the school will act as fiscal agent for any monies awarded.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Printed Name:
Date of Signature Date of Signature / MM / DD YYYY
Signature of Principal or Authorized Administrator
In signing this application, the adult advisor/director verifies that the applicant is a registered student organization and that the school will act as fiscal agent for any monies awarded.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Printed Name:
Date of Signature Date of Signature / MM / DD YYYY