PRESCOTT EVENING LIONS (PEL) FOUNDATION 2014 Grant Application Please complete this two-page Grant Application in its entirety. Submit no later than the published deadline. DEADLINE: April 1, 2014. Applications received after the deadline will not be considered for this year. Mail or deliver to: PEL Foundation Grants, Attn: Ken Leja, 405 Long Branch West, Prescott, AZ 86303. CONTACT INFORMATION: Organization Name _________________________________________________________________________________________ Director _______________________________________________ Mailing Address / City / Zip _________________________________________________________________________________________ E-mail Address _________________________________________________________________________________________ Phone __________________________________ PROGRAM / PROJECT INFORMATION: Contact Name _______________________________________________ Phone ___________________________________ Current Funds available for this Project/Program $______________ Total Program/Project Budget $______________ Amount requested from PELC Foundation $______________ Program/Project Start Date Program/Project End Date _____/_____/_______ EXPLANATION OF PROGRAM / PROJECT: _____/_____/________ (include an additional sheet if necessary) AGREEMENT AND SIGNATURE: By submitting this Application, I affirm that the information set forth is true and complete, and that the decision of the Board of Directors of the Prescott Evening Lions and Prescott Evening Lions Foundation is final. Signature __________________________________________________________________________________________ Name (printed) __________________________________________________ Date PAGE ONE OF TWO ____________________________ PEL Foundation 2014 Grant Application – page 2 PRIOR FUNDING: If your organization received any grant funding from the Prescott Evening Lions Foundation in 2011, 2012 or 2013, please describe IN DETAIL how the funds were utilized. Include an additional sheet if necessary. A business financial statement for 2013 would be helpful. If no prior grant, please indicate by writing “none” in the space. ORGANIZATION BACKGROUND: What is the mission of your organization? Are you an IRS 501(c)(3) designated non-profit organization? □Yes □No ________________________________________________ Are you a Qualifying Charitable Organization eligible to receive Arizona “Working-Poor” funding for 2014? □Yes □No _____________ Number of paid members or staff in your organization? _________________________________ Number of Volunteers? __________________________________ How many persons are served by your organization? ________________________________ Is this a one-time program or is it an ongoing program? ______________________________ How many persons are (or would be) served by the proceeds of this grant request? ____________________________________________ What are your other sources of funding? (please indicate details and amounts) In evaluating grant applications, we may request that a member of our funding committee arrange a time to visit your facility to review your grant request. Should a grant be approved and you receive funding, we may also request that a member of your organization make a short presentation to our membership of the results and benefits garnered through this grant funding. Grants are generally funded after May 15. Thank you for completing this application and your support of the Prescott Evening Lions. Prescott Evening Lions Ken Leja Chair, 2014 grants committee 405 Long Branch West, Prescott, AZ 86303 (928) 830-8236 cell PAGE TWO OF TWO