COMMUNITY GRANT - APPLICATION
WHICH GRANT ARE YOU APPLYING FOR? *
ORGANIZATION ADDRESS *
ORGANIZATION ADDRESS
City
State/Province
Zip/Postal
ARE YOU TAX EXEMPT *
$
$
IF NEEDED UPLOAD A FURTHER PROJECT DOCUMENT
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IS THIS AN ON GOING PROJECT *

Please attach a current year budget for your program, also specify budgeting for this particular grant request. Include last years budget if applicable

PROGRAM SPECIFIC BUDGET - CURRENT YEAR *
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Maximum upload size: 516MB
PROGRAM SPECIFIC BUDGET - CURRENT YEAR *
Drag and drop your file here to upload your document(s) or click here to open an upload dialog box to select your documents Choose File
Maximum upload size: 516MB
IF AWARDED FUNDING FROM JSL, WOULD YOUR ORGANIZATION BE WILLING TO ADD JSL'S LOGO TO YOUR PROMOTIONAL MATERIAL AND/OR DISPLAY SIGNAGE IN A COMMON AREA OF YOUR AGENCY? *
I CERTIFY THAT THE AFOREMENTIONED AGENCY HAS RECEIVED TAX EXEMPT STATUS UNDER THE INTERNAL REVENUE CODE 501 (C)(3). *
I CERTIFY THAT THE AFOREMENTIONED AGENCY'S ORGANIZING DOCUMENT AND BY-LAWS ARE UP TO DATE AND APPLICABLE TO THE AGENCY'S CURRENT OPERATION. *
I CERTIFY THAT THE AFOREMENTIONED AGENCY HAS BEEN INCORPORATED AS A NON-PROFIT ORGANIZATION FOR AT LEAST TWO YEARS BEFORE COMPLETING THIS APPLICATION. *
I CERTIFY THAT THE AFOREMENTIONED AGENCY HAS AT LEAST A THREE-MEMBER LOCAL BOARD OF DIRECTORS OR ADVISORY BOARD/COUNCIL WHICH GOVERNS THE AFFAIRS OF THE ORGANIZATION. THE BOARD/COUNCIL INCLUDES VOLUNTEERS WHO REPRESENT A CROSS-SECTION OF MESA COUNTY RESIDENTS. *
I CERTIFY THAT THE AFOREMENTIONED AGENCY EXISTS TO SERVE PEOPLE GENERALLY, AND HAS ADOPTED A POLICY OF NON-DISCRIMINATION THAT IS IN COMPLIANCE WITH ALL STATE AND FEDERAL LAWS, APPLICABLE TO PERSONS SERVED, STAFF EMPLOYMENT AND MEMBERSHIP ON ITS GOVERNING BOARD. *
I CERTIFY THAT THE AFOREMENTIONED AGENCY HAS AT LEAST ONE STAFF PERSON, SALARIED OR UNSALARIED, ASSIGNED AT LEAST HALF TIME TO CONDUCT AND/OR ADMINISTER THE ACTIVITIES OF THE ORGANIZATION. *
I CERTIFY THAT THE AFOREMENTIONED AGENCY HAS AN INDEPENDENT ANNUAL AUDIT OR REVIEW PREPARED BY A CPA. *
I CERTIFY THAT THE AFOREMENTIONED AGENCY HAS FILED A CURRENT FORM 990 WITH THE INTERNAL REVENUE SERVICE. *
I AM THE DULY APPOINTED REPRESENTATIVE OF THE AFOREMENTIONED ORGANIZATION, AUTHORIZED TO CERTIFY AND AFFIRM STATEMENTS OF THIS ELIGIBILITY DETERMINATION FORM. *
UPLOAD ANY OTHER DOCUMENTATION YOU WISH TO HAVE CONSIDERED
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Maximum upload size: 516MB