Board of Community Action
Grant Application Form
March, 2010
Application Procedures:
A Grant Application Form must accompany each request for funding. All
fields should be filled in. You can download a Microsoft Word or PDF version of this application. Please read the accompanying Grant
Guidelines and eligibility criteria before applying.
Grant requests are reviewed in March.
Applications must arrive at the Church office on or before February 28. The
completed application must be emailed to the following address: SSutton@westmorelanducc.org
If you are unable to submit the application by email, please contact
the church for directions about completion and delivery of the
application.
Westmoreland Congregational
UCC Phone: (301)
229-7766
All applicants will be notified of the Board of
Community Action's
funding decisions. A list of the awardees will be posted on
Westmoreland's Web Site.
Please complete all fields:
Submission date: ______________________________________________
1. Name of organization: ________________________________________
Name of Director: _____________________________________________
Address of Organization: ________________________________________
___________________________________________________________
Organization's Phone Number _________________Fax________________
Organization's E-Mail: __________________________________________
Name & Title of Contact Person:
__________________________________
___________________________________________________________
E-Mail of Contact Person: _______________________________________
Contact phone number: ________________________________________
Amount Requested: $__________________
2. Please describe your organization's core focus, mission or
activities: (A brief statement may be supported by a brochure or single
page summary):
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
3. How will your organization use the grant funds to promote individual
or community self-reliance, foster ecumenical or intra-denominational
cooperation, or provide direct services?
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
4. If applicable, please indicate approximately the number of the
people (infants, children, adolescents, adults or seniors) benefiting
from this award?
Infants (under 1 year of age) ____ Children ____ Adolescents ____
Adults ____ Seniors ____
5. Please list the member(s) of Westmoreland who have volunteered at
your organization within the last year.
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
7. Please indicate the interest and involvement of the Westmoreland
members:
Donates food/clothing or supplies ____ Tutors ____ Fund Raises ____
Develops policies ____ Provides office support ____ Board Member ____
Other activities _____________________
8. Please include all of the following documents. If they are not
available, please explain why:
A. Most recent annual report.
B. Most recent full year budget that is available.
C. IRS tax determination letter indicating that your organization is
recognized as a public charity under Section 501(c) (3).
D. Please write below the exact name of the organization that should
appear on the check.
E. Please indicate the address where the check should be sent.
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
11/09/2007 Grant Guidelines – WCUCC
Last updated Friday, October 02, 2009.
1 Westmoreland Circle
Bethesda, MD 20816
301-229-7766
Email the church office: churchinfo@westmorelanducc.org
www.westmorelanducc.org
An Open and Affirming Congregation
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