Application Form TEST

1. Application Review Meeting Date*
"September Review" - Applications must be received between May 1 at 5:01pm and August 1 at 5pm"November/December Review" - Applications must be received between August 1 at 5:01pm and October 1 at 5pm"March Review" - Applications must be received between October 1 at 5:01pm and February 1 at 5pm"June Review" - Applications must be received between February 1 at 5:01pm and May 1 at 5pm

2. Organization Name*

3. EIN (or Group EIN)*

4. Mailing Address*

5. Contact Person Name*

6. Email Address*

7. Phone*

8. Year organization founded*

9. If under group ruling, name of Group holder

10. Organization Category*
-- Please Select --Animal Welfare/EnvironmentalArts/Culture/HumanitiesHealth/Medical/Scientific ResearchHuman ServicesReligious Causes - CatholicReligious Causes - Non-CatholicWomens InitiativesYouth DevelopmentOther

11. Grant Purpose*
-- Please Select --General SupportSpecific ProjectCapital Campaign

12. Amount Requested*

13. Specific Project Name

14. Total Project Budget

15. Total Project-related Payroll Expenses

16. Pending Projects Funds
Please include funds committed from other sources but not yet received.

17. Total Project Funds received to-date.

18. Project Start Date

19. Project End Date

20. Last Fiscal Year End: MM/DD/YYYY*

21. Total Operating Revenue*

22. Total Contributions and Grants from Outside Sources*

23. Total Contributions from United Way*

24. Total Grants received from Foundations & Corporations*

25. Total Government Grants or Contracts*

26. Total Fees, Tuitions, Dues, & Retails Sales*

27. Total Funds Received through Fundraising Events*

28. What percentage of your Board of Directors made a financial contribution to your organization during the last year?*

29. What percentage of your Board of Directors volunteered time and/or services to the organization beyond attending Board meetings last year?*

30. Approximately how many volunteers work with your organization each year?*

31. What percentage of your full-time staff are volunteers?*

32. Total salary expenses (Please include payroll as well as payroll-related taxes and benefits costs)*

33. How many full-time staff do you employ?*

34. How many part-time staff do you employ?*

35. What are the total estimated volunteer hours given to your organization?*

36. What is your Mission Statement?*
500

37. How is your organization governed? (Board of Directors, Advisory Committee, etc.)*
500

38. Briefly Summarize Your Target Population*
500

39. Briefly describe the project and how it will address a need in the community*
500

40a. Have you received funding from the Cameron Foundation in the last 5 years?*
-- Please Select --YesNo

All of the following documents are required: