APPLICATION FOR RECREATION PROJECT

Due April 16, 2018 for 12-month funding period (July 1-June 30); funds become available July 1, 2018.

Please read the Policies and Procedures attached to this form.
All applications must be submitted to 601 West Lott, Buffalo, WY 82834
Original and seven copies by 2:00 p.m. on the due date.
Applications may also be mailed to the address above and must by postmarked no later than April 16, 2018
Applications will not be accepted electronically or by fax.
Applications must be signed by a building supervisor or principal, if being submitted by a JCSD #1 employee.
Application must be signed by a representative of the City of Buffalo if submitted by any of its political subdivisions.
Applications must be signed by a representative of the Town of Kaycee if submitted by any of its political subdivisions.
Applications must be signed by a representative of Johnson County if submitted by any of its political subdivisions.
An incomplete application will not be considered. Although incomplete applications will be returned to applicants by U.S. Mail,
JCRD is not obligated to notify applicants of incomplete applications prior to the application due date.
It is mandatory that all applicants present their proposals. Grant funds will not be given to any organization or event that does not make a presentation
Funds must be requested by December 31 of each year. If a project has not been completed by the end of the funding cycle, a status report is to be submitted; however, the Board expects that funds will be used within the funding period for which they are granted.

GRANT POLICIES AND PROCEDURES CAN BE FOUND AT THE END OF THIS APPLICATION. IT IS THE APPLICANTS RESPONSIBILITY TO REVIEW THESE PRIOR TO COMPLETING THIS APPLICATION.

Please complete the following. Attach additional sheets as needed.

NAME OF PROJECT

What are the beginning and ending dates of your project?(Please refer to the funding availability dates to make sure your project does not incur expenses before funding would be available.)

Name of Club/Organization

Address of Club/Organization

City/State/Zip

Phone Number

E-mail address

Name of primary contact or sponsor

Phone number & e-mail address if different from above

Organization Type

Has this project been funded by JCRD in the past?

What is the total dollar amount requested from JCRD for this project?

Describe your club/organization by answering the following:
1. What is the purpose of your club/organization?
2. When are the club’s/organization’s regularly scheduled meeting dates and times (e.g. weekly on Thursdays at 4 p.m., or the third Thursday of every month?)
3. If you do not meet regularly, how often and when do you plan to meet to implement your project?
4. How many members are involved with your club/organization?
5. What age group does your club/organization involve?
6. How many officials/sponsors are involved with your club/organization?
7. What is the sponsor-to-member ratio?
8. What is the name and title of the adult primarily responsible for the club/organization?
What is the primary purpose of your project and how does it support the purpose of the JCRD, which is to “support programs to increase community participation in a variety of recreational endeavors which are available to the public”?
1. Specify what recreational opportunities will be provided to the public through your project and how many people do you expect to participate in your project.
Why should this project be funded?
Describe in detail what activities will be involved in your project and how those activities relate to the purpose of your project.
Please list any websites that pertain to this club, organization or project.
Please list in detail any equipment or supplies that will be needed to implement/run the project, and the estimated costs. Please be specific (e.g. “6 basketballs at $20 each for a total of $120” is acceptable, whereas “balls - $120” is not acceptable). You may attach a separate list if necessary.
If your application could potentially impact structures or grounds of the Johnson County School District #1, including electrical, plumbing and HVAC, the application must be reviewed by the JCSD #1 Maintenance Department prior to submitting the application. A copy of the completed work order signed by maintenance personnel must be included with the application. Applications will not be considered without this documentation, and will be returned.
Please list in detail any travel expenses the project will require. Please include departure and return dates, destination(s), mode of transportation, number of participants (adults and minors) traveling, and any other pertinent information.
Describe how you will advertise, promote and/or notify the public about your program to insure the public is aware of the recreational opportunity.
What kind of training, if any, will be required to implement/run the project?
What is the name, title and relationship to the club/organization of the person responsible for implementing and maintaining the project?
Describe other financial contributions, in-kind, case or matching funds, which have been or will be made toward this project, if any?
Is this a one-time request or will future funding be needed to continue this project?
If the project will extend past the grant period, what are the club’s/organization’s plan for sustaining the project?

Attach a timeline or action plan for your project. Attach a detailed projected budget for your project, itemizing all expenses. You may use the attached form, or develop any format that you think explains the project’s budget. Additionally, if you are reapplying, you must attach a final report or status report.

By signing this application I acknowledge that I have read and will comply with all policies and procedures of the Johnson County Recreation District.

Signing Date

Applicant Signature

Date Of Birth

Note: JCRD funds are available because of a recreation mill levy in the county. This is made possible by an act of the legislature and action taken by the JCSD #1 Board of Trustees. These funds can be used only for community public recreation purposes. Additional information can be gained by attending any JCRD board meeting.

JCRD does not discriminate on the basis of race, color, national origin, sex, age, disability, political affiliation, religion or belief.

JOHNSON COUNTY RECREATION DISTRICT (JCRD)

Budget Form

Agency		EXPENSES	AMOUNT
		Staff Salaries (employees of agency)
		Staff Benefits
Program		Contracted Services (professional services, bookkeeping, etc)
REVENUE	AMOUNT	Repairs & Maintenance
(Please list all monies available to this project/agency)		Rental
		Postage
Funds requested from JCRD		Telephone
Fees		Advertising
In-Kind Contributions		Printing
Donations		Supplies
Other Grants		Equipment & Machinery (provide detailed list)
Other Cash/Funds		Dues & Fees
Other Revenue(Please describe)		Other Expenses (Please describe)
TOTAL REVENUE/FUNDS		TOTAL EXPENSES
Reminder: When completing a budget, the revenues and expenses must balance
Date		Completed by:
Additional Comments
Note: You may supply additional information with this form as an attachment.

END OF APPLICATION

THIS DOCUMENT FOR INFORMATION ONLY – DO NOT INCLUDE WITH APPLICATION

JOHNSON COUNTY RECREATION DISTRICT (JCRD)

Purpose: Support programs to increase community participation in a variety of recreational endeavors
Which are available to the public.

GRANT POLICIES & PROCEDURES

Grants will not be considered for academic programs. All projects must be recreational in nature.
All activities/programs are to be available to the public, as appropriate for children or adults, and are to be advertised appropriately.
Private and public agencies may be funded once per twelve-month per month period unless determined otherwise by the Johnson County Recreation Board.
Non-district organizations are defined as those with federal tax identification numbers. Non-district organizations will be required to include their federal tax identification number to qualify for funding.
Equipment necessary to initiate or enhance a program will be considered. Applications must justify expenditures for equipment.
Final reports are required for all completed projects. Final reports are required to maintain eligibility for future funding.
If a project has not been completed by the end of the funding cycle, which is June 30th of the following year, a status report is to be submitted; however, the Board expects that funds will be used within the funding period for which they were granted.
Expenses for travel will be paid under the following circumstances:
1. Travel expenses will be limited to event registration, transportation, lodging and meals.
2. Travel expenses will be allowed for a limited number of chaperones as approved through the grant application process. Chaperones should be justified within the application and must be at least 21 years old.
The JCRD Board recommends that a wage of not more than $20 per hour is an appropriate amount to be paid for projects supported by JCRD funding.
Successful grant applicants must submit request by December of each year. If funds are not requested by this date, the grant funds will be returned to the grant pool.
Grants submitted that improve property of the City of Buffalo or Johnson County School District #1 shall show how project shall be sustained.
All projects shall be branded and proof submitted with the final report.

THIS DOCUMENT FOR INFORMATION ONLY – DO NOT INCLUDE WITH APPLICATION

NOTICE TO NON-PUBLIC ENTITIES OR INDIVIDUALS APPLYING FOR JCRD FUNDS

The application for JCRD funds requires that you identify the tax status of your organization and provide a tax identification number or social security number. The number is for reporting by the JCRD for IRS income tax purposes.

You should be advised that if your organization is not a non-profit organization with tax exempt status approved by the Internal Revenue Service there may be income tax consequences to your receipt of the JCRD funds. A Wyoming non-profit corporation is not tax exempt for IRS income tax purposes unless the corporation’s exempt status has been approved by the IRS.

You should consult with a CPA/accountant or an attorney to determine your tax/legal status.