MFTF Grant Application

Please Note: All files must be in one of the following formats to be accepted: Word, Excell, PDF, Plain Text Document. Please do NOT upload image file types! If you need to use a scanned image, please reduce the file size first, and then add it to a document. File size restrictions apply - no more than 100k per document. You may download a FREE PDF converter from: http://www.cutepdf.com/Products/CutePDF/writer.asp If you have problems uploading files or cannot provide files in the required formats; please upload a blank document in its place, and then contact MFTF for further instructions. Thank You! Mildred Falkner Truman Foundation
Date
Name of organization (Exact legal name)*
Does your organization have a religious affiliation? (If yes attach a one page explanation)*	Yes No
Religious affiliation explanation (if applicable)
Attach copy of tax exemption letter from IRS
Address 1*
Address 2
City*
State*
Zip Code*
Phone*
Email
Website
Executive Director*
Grant contact person (if not Executive Director)
Amount of Grant Request*
Summarize purpose of grant (limit to 3 sentences)*
Attach 1 page (maximum) description of project and benefit to Tioga County residents*
Check one*	Seed support Special Project support Capital Project support
Total organizational budget (for current year)
Dates covered by this budget (mo/day/year - mo/day/year)
Attach 1 page budget summary showing income and expenses for this current year
Attach 1 page list of organization's Board of Directors, include county of residence
Number of paid staff: Full-Time*
Number of paid staff: Part-Time*
Number of volunteers*
Attach 1 page explanation if organization has experienced a deficit in past three years
Total project or seed budget
Attach 1 page (maximum) of project/seed budget
Attach 1 page timetable*
Dates covered by this budget (mo/day/year - mo/day/year)*
Attach estimates for project
Attach 1 page list of all sources of funding toward project (include actual and prospective amounts)*
What percentage of your income goes towards raising funds?
Evaluation: Explain results you expect to achive from this project and how you will measure project's success (limit to three sentences)*
We, the undersigned, represent to the Mildred Falkner Truman Foundation that the organization's annual budgetary information is true and accurate.
Digital Signature: Board Chair, Indicating Approval*
Date (day/month/year)*
Digital Signature: CEO/Executive Director*
Please note that the mildred Falkner Truman Foundation shares information with other funders. Information regarding any Truman Foundation grant decision concerning your organization may be disclosed in the information exchange process.
Accept Terms*