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Guilford Green Foundation
2007 Grant Application
Please complete this Grant Application in accordance with Attachment A, Guidelines. Submit completed Grant Application and attachments to: Gifting Committee, Guilford Green Foundation, 330 South Greene Street, Greensboro, NC 27401.
Completed Grant Application must be postmarked no later than July 27, 2007.
I. GENERAL INFORMATION
Name of Organization or Institution (referred to hereinafter as “Grant seeker”):
GSAFE – Gay Straight Advocates for Education
Address: PO Box 41044, Greensboro, NC 27404
Website: www.gsafe.org
Contact information for Grant seeker: Gary Palmer
Contact’s Name and Title: Gary Palmer, Chair
Telephone: 336-271-8428 Fax: Email: gary.palmer@replacements.com
If incorporated, please provide date of incorporation (month/day/year): August 26, 2005
II. POPULATIONS SERVED
A. Grant seeker serves the following populations (please check all that apply):
Persons who are:
Lesbian
Gay
Bisexual
Transgendered
The LGBT Community
under age 21
between ages 21 and 65
over age 65
Racial Minorities
Ethnic Minorities
□ with Serious Health Conditions
□ Disabled
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B. Please describe, in a few sentences, the individuals or communities you serve.
We serve the students, staff and faculty of public and private schools, primarily in Guilford County. We do respond to questions and requests outside of Guilford County, including having one board member from Liberty, NC who is trying to affect change there.
III. GRANT SEEKER’S OPERATIONS
A. Grant seeker’s General Purpose (please check all that apply):
□ Arts and Culture Human Services
□ Education □ Faith/Religious
□ Health □ Other (please describe below)
B. What is Grantseeker’s organizational or institutional mission?
The purpose of the Gay Straight Advocates for Education, Inc. includes but is not limited to: (a) providing for the promotion of a public policy by which schools are alleviated from discrimination and harassment on the basis of sexual orientation and/or gender identity/expression so that all students, faculty, staff and other school community members are made physically and emotionally safe; (b) providing resources which address the educational, emotional, psychological, and spiritual needs and wants of gay, lesbian, bisexual, transgender youth and their allies; and (c) providing for the furtherance of the goals of valuing and respecting gay, lesbian, bisexual and transgender persons in educational environments.
C. What are the start and end dates of Grantseeker’s current fiscal year?
July 1, 2006 – June 30, 2007
D. What is Grantseeker’s total annual budget for the current fiscal year?
E. What was Grantseeker’s total annual budget for the prior fiscal year?
F. If budgeted, what is Grantseeker’s total annual budget for the coming fiscal year?
G. What percentage of Grantseeker’s budget is raised from Grantseeker’s own fundraising efforts?
IV. GRANT FUNDING SPECIFICS
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A. Being as specific as possible, what is the particular initiative, project or activity for which funds are now being requested from the Guilford Green Foundation?
We are trying to send as many GSAFE board members as possible to the 3 day PFLAG Conference in McLean, Virginia in October of 2007. PFLAG has a strong educational component at the conference which we want to use for training on GLBT educational issues. We have 10 of our board members attending. Five people are also attending a pre-conference lobby day.
B. For the particular initiative, project or activity described in (IV.A) above, what is the total dollar amount Grantseeker is requesting from the Guilford Green Foundation?
$4,500
C. What is the total budget for the particular initiative, project or activity described in (IV.A) above?
$6,256.27
D. Have other funds been raised or allocated toward meeting the budget identified in (IV.C) above?
Yes □ No
If yes, how much has been raised or allocated as of the date of this Grant Application?
$1,638.20
E. If the particular initiative, project or activity described in (IV.A) above is an ongoing program, please describe plans for continued funding of this program.
PFLAG does not have a yearly conference. They hold them every 2 or 3 years.
F. What are the start and ending dates for the particular initiative, project or activity described in (IV.A) above?
October 11-14, 2007
V. GRANT RECEIPT SPECIFICS
A. If Grantseeker were to receive a Guilford Green Foundation grant for the particular initiative, project or activity described in (IV.A) above, how exactly would those funds be allocated and used? Please be as specific as possible.
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B. If Grantseeker were to receive a Guilford Green Foundation grant for the particular initiative, project or activity described in (IV.A) above, please describe the method of implementation, whether staffing will be involved, and the number and type of volunteers, if any, who will support implementation.
C. If Grantseeker were to receive a Guilford Green Foundation grant for the particular initiative, project or activity described in (IV.A) above, what outcome is envisioned? What accomplishments or changes may result?
D. What tools or measures will you apply to evaluate the success or failure of a Guilford Green Foundation grant?
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VI. OTHER INFORMATION
A. Is there anything not already covered in this Grant Application you would like the Guilford Green Foundation to know about your organization or institution?
B. Assuming money were no object, what unmet needs in our community would your organization or institution like to see addressed?
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VII. TERMS AND CONDITIONS
As a condition to being considered for any grant the Guilford Green Foundation, in its sole discretion, elects to make to Grantseeker, Grantseeker agrees as follows:
• Grantseeker is a non-profit organization exempt from federal income taxation under Section 501(c)(3) of the Internal Revenue Code;
• Grantseeker attests that a majority of its membership and/or the population it serves reside in the North Carolina Triad area (including Alamance, Davidson, Guilford, Randolph or Rockingham counties);
• Grantseeker agrees to use any grant funds received from the Guilford Green Foundation within Triad or for the benefit of residents of Alamance, Davidson, Guilford, Randolph or Rockingham counties;
• Grantseeker agrees, as a condition to accepting any funds from the Guilford Green Foundation, that the Guilford Green Foundation may, in its sole discretion, make public the fact that its organization or institution is a grant recipient, the activities or purposes for which such grant is made, and the amount and manner in which any such funds would be used;
• Grantseeker authorizes any publicity or documentation that demonstrates a granter-grantee relationship, should your organization or institution accept funds from the Guilford Green Foundation;
• Grantseeker agrees, as a condition to accepting any funds from the Guilford Green Foundation, that any funds granted by the Guilford Green Foundation be used solely and exclusively for the purpose, and within the time period, requested in this Grant Application, and that any differing use(s), or any use(s) within any differing time period(s), be pre-approved, in writing, by a vote of the Guilford Green Foundation Board of Directors;
• Grantseeker agrees to provide the Guilford Green Foundation with a year end accounting of the funds use for their granted purpose; and
• Grantseeker agrees, as a condition to accepting any funds from the Guilford Green Foundation, to promptly repay to the Guilford Green Foundation the grant monies received in the event (i) your organization or institution makes any unauthorized use(s), or any use(s) within any differing time period(s), that materially differ from the use(s), and/or time period(s), provided for in the Grant Application, (ii) that you fail to make a year end accounting report, or (iii) that this Grant Application contains any material misstatement or omission.
I hereby certify that I am authorized to sign this Grant Application on behalf of (please insert Grantseeker’s name) ________________________________________, that I have fully read this Grant Application and Attachment A, that I understand and agree with its terms and conditions, and that, to the best of my knowledge, this Grant Application is true, correct, and complete.
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Signature Date
__________________________________________________________________________________
Type or Print Name Title or Authority of Signer
Applications must be postmarked no later than July 27, 2007.
Submit completed Grant Application and attachments to:
Gifting Committee, Guilford Green Foundation, 330 South Greene Street, Greensboro, NC 27401
