Community Investment Grant

Application Process

#### Application Deadline
December 5th by 5:00 PM

#### Section 1 - Contact Information (Required)
1. Organization name (must match IRS Form 990)
2. Organization address and mailing address
3. Phone and email contact information
4. Website
5. IRS Tax ID Number (format XX-XXXXXXX)
6. Year organization founded (month, day, year)
7. Contact name and phone
8. Identify if organization uses another organization for fiscal management/administration
9. Specify where grant awards should be mailed
10. Confirm if organization is an audited federal and/or state government entity

#### Section 2 - Amount Requested and Certification (Required)
1. Service title(s)
2. Total award amount requesting for all services
3. Sign compliance agreement affirming:
- Compliance with USA PATRIOT ACT and counterterrorism laws
- Active and responsible governing body with no material conflicts of interest
- Organization chartered or incorporated in State of Tennessee
- Information provided is true and accurate
4. Organization Executive signature and printed name with date
5. Organization Board Chair signature and printed name with date

#### Section 3 - Financial Stewardship and Managerial (Governance) Stewardship (Required)
1. Describe fraud prevention process
2. Describe board of directors' involvement in governance, budgeting, planning, and fundraising (include meeting frequency)
3. Describe how and who reviews organizational financial information and assets
4. Confirm organization has bylaws and/or operational documents; if yes, provide brief description of general areas covered
5. Provide insight into changes affecting organization's financial security or insecurity
6. Submit strategic plan (required for requests $5,000+; for requests under $5,000, submit either strategic plan or one-page strategic direction document, all dated)
7. Describe organization's mission
8. Confirm organization information is up to date on RCUW Volunteer Clearinghouse
9. Confirm representative attends RCUW Interagency meetings periodically
10. Describe how organization has engaged in partnerships or initiatives with other organizations
11. List planned fundraisers for 12-month period
12. Provide additional comments regarding financial and managerial stewardship

#### Section 4 - Outcomes Achieved (Required - for each service up to 4 services)
For each service:
1. Confirm if received RCUW funding in recently completed 12-month period (April 1 - March 31)
2. Service title
3. Service description
4. Focus area selection (Health, Education, or Financial Stability)
5. Demographics of those served
6. Describe eligibility requirements (if any)
7. Describe service fee structure (if any)
8. Provide brief description of performance measures and outcomes achieved for 12-month period including:
- Description of service recipients
- Cost to deliver
- Number of recipients
9. Describe impact of service delivery and how impact was measured
10. Describe how results were communicated to donors and board
11. If received RCUW funding in recently completed period, provide outcome results based on previous application description
12. Provide additional comments regarding outcomes achieved

#### Section 5 - Funds Request (Required - for each service)
For each service requesting funds:
1. Service title
2. Amount requested for this service
3. Service description including:
- Expected service recipient demographics
- Who will deliver service
- When and how often service will be delivered
- Estimated cost to deliver per recipient
- Any partnerships with other organizations
4. Service objective
5. Number of years service has been delivered by organization
6. Number of years service has been delivered in Roane County
7. If service is provided by another local organization, describe how your organization's service differs
8. Select primary focus area (Health, Education, Financial Stability)
9. Describe need:
- How and when need was identified
- Estimate number of Roane Countians needing service

#### Required Supporting Documents (submitted separately via email)
Email to Community Impact Coordinator:
1. Confirmation that you have submitted grant application via website
2. Current IRS Determination Letter (501(c)(3) status)
3. Current registration or exemption letter from State of Tennessee, Division of Charitable Solicitations
4. Most recent IRS Form 990 (organization name in file name)
5. Strategic plan or one-page strategic direction document (dated; organization name in file name)
6. Bylaws and/or operational documents (organization name in file name)
7. Financial documentation as specified in instructions

#### File Naming Convention
All attached files should have organization name in file name with title of document. Examples: "RCHELPSPEOPLE Inc FY 2015 990", "RCHELPS Inc Strategic Plan". Shortened organization title and/or recognizable acronym acceptable (e.g., MECAA, SCHAS).

#### Submission Instructions
1. Complete and submit application through online form
2. Save completed application as PDF (can also submit PDF of signature page separately)
3. Submit supporting documentation via email to Community Impact Coordinator