Johnson County Recreation District — Grant Application
#0 — Sample Project
| Application ID | Project | Fiscal Year | Status | Begin | End |
|---|---|---|---|---|---|
| #0 | Sample Project | 2017 | Editing | 1/1/17 | 1/1/18 |
1Project Basics
Project Name
Sample Project
Organization
Organization / Club Name
Sample Club
Address
Buffalo
City
Sample City
State
Sample State
ZIP
Sample Zip
Phone Number
555-555-5555
Email
sample@example.com
Tax / Sponsor Information
Federal Tax Identification Number
00-0000000
Business Type
Sample Organization Type
Organization name associated with this Federal Tax ID
Sample Name on Tax ID Number
Is the above organization a fiscal sponsor?
Yes/No
Primary contact / fiscal sponsor name
John Smith
Additional phone numbers / email addresses
555-555-5555, john.smith@example.com
2Project Details
Previously Funded by JCRD?
Sample Previously Funded
Total Amount Requested
$0.00
One-time or Ongoing?
Sample Project Type
1
Describe your club/organization by answering the following:
a
What is the purpose of your club/organization?
Sample Purpose for Organization
b
When are the club’s/organization’s regularly scheduled meeting dates and times?
Sample Meeting Dates
c
If you do not meet regularly, how often and when do you plan to meet to implement your project?
Sample Other Dates
d
How many members are involved with your club/organization?
99
e
What age group does your club/organization involve?
10-15 Yrs
f
How many officials/sponsors are involved with your club/organization?
99
g
What is the sponsor-to-member ratio?
10:1
h
Name and title of the adult primarily responsible for the club/organization.
John Smith
2
What is the primary purpose of your project and how does it support the purpose of the JCRD (“support programs to increase community participation in a variety of recreational endeavors which are available to the public”)?
Sample Purpose of Project
a
Specify what recreational opportunities will be provided to the public, and how many people you expect to participate.
Sample Recreational Opportunities
3
Why should this project be funded?
Sample Reason for Funding
4
Describe in detail what activities will be involved in your project and how those activities relate to the purpose of your project.
Sample Activities
5
Please list any websites that pertain to this club, organization, or project.
Sample Websites Link
6
Please list in detail any equipment or supplies needed and estimated costs (e.g. “6 basketballs at $20 each for a total of $120”). You may attach a separate list if necessary.
Sample Equipment Details
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.
7
Please list in detail any travel expenses the project will require (departure/return dates, destinations, mode of transportation, number of participants, and any other pertinent information).
Sample Travel Expenses
8
Describe how you will advertise, promote and/or notify the public about your program.
Sample Advertisement
9
What kind of training, if any, will be required to implement/run the project?
Sample Training
10
Name, title, and relationship to the club/organization of the person responsible for implementing and maintaining the project.
Sample Main Person
11
Describe other financial contributions, in-kind, cash, or matching funds which have been or will be made toward this project, if any.
Sample Financial Contributions
12
If the project will extend past the grant period, what are the club’s/organization’s plans for sustaining the project?
Sample Extend Date Passed
13
Have you received or are applying for funding from one of the following?
City
No
County
No
State
No
School District
No
3Budget
| Project Revenues | |
|---|---|
| Revenue Category | Amount |
| Funds Requested from JCRD | $0.00 |
| City | $0.00 |
| County | $0.00 |
| State | $0.00 |
| School District | $0.00 |
| Fees | $0.00 |
| In-Kind Contributions | $0.00 |
| Donations | $0.00 |
| Other Grants | $0.00 |
| Other Cash/Funds | $0.00 |
|
Other Revenue (Please describe) Sample Other Revenue Explaination |
$0.00 |
| Total Revenue | $0.00 |
| Project Expenses | |
|---|---|
| Expense Category | Amount |
| Staff Salaries (Employees of Agency) | $0.00 |
| Staff Benefits | $0.00 |
| Contracted Services (professional services, bookkeeping, etc.) | $0.00 |
| Repairs & Maintenance | $0.00 |
| Rental | $0.00 |
| Postage | $0.00 |
| Telephone | $0.00 |
| Advertising | $0.00 |
| Printing | $0.00 |
| Supplies | $0.00 |
| Equipment & Machinery (provide detailed list) | $0.00 |
| Dues & Fees | $0.00 |
|
Other Expenses (Please describe) |
$0.00 |
| Total Expenses | $0.00 |
Reminder: when completing a budget, the revenues and expenses must balance.
4Supporting Documents
No documents submitted
5Sponsor Approval
Does this project require signoff from another party (e.g. Principal, designated city/county supervisor, etc.)? No
6Signature & Comments
| Additional Comments: | |||
| Date: | Completed by: | ||
| Note: You may supply additional information with this form as an attachment. | |||
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.
Date
Signing Date
Applicant Signature
NO SIGNATURE
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.