Grant applicants may submit either the following Grant Application Cover Sheet (with blanks filled in) or the Maine Philanthropy Center Common Grant Application B Format as the first page(s) of the application.

**All application documents to be submitted in seven (7) full counterparts or copies.**

GRANT APPLICATION COVER SHEET
PDF

***SUBMIT SEVEN (7) FULL COPIES OF YOUR PROPOSAL***

DATE:______________________________

NAME OF ORGANIZATION, MAILING ADDRESS, EMAIL AND WEBSITE (IF ANY) ADDRESSES, TELEPHONE AND FAX NUMBERS:

NAME OF PERSON TO CONTACT, TELEPHONE NUMBER AND EMAIL ADDRESS:

Please check whichever of the following applies to your organization’s Tax Status:
____GOVERNMENT AGENCY
____501(c)(3) PUBLIC ORGANIZATION*

*Attach a copy of the US Internal Revenue Service Letter which indicates your tax status. If your organization is doing business under a d/b/a (fictitious business name) or has changed its name from the name on the IRS Exemption Letter please include proof of same

____PENDING APPLICATION FOR TAX EXEMPT (IRC 501(c)(3) public organization status)
____FISCAL SPONSORSHIP BY ANOTHER MAINE ORGANIZATION WHICH IS ITSELF TAX EXEMPT*
Specify its name: ___________________________ and provide further information as specified in “Grant Guidelines and Application Procedures”

TITLE OF YOUR PROPOSAL (not to exceed 6 words):

ATTACH:
• A SUCCINCT DESCRIPTION OF YOUR PROPOSAL not to exceed 5 pages, font size 12 pt or larger
• MOST RECENT PAST FULL-YEAR FINANCIAL STATEMENTS OF YOUR ORGANIZATION, AUDITED IF AVAILABLE (Balance Sheet plus Statement of Income and Expenses)
• BUDGET FOR ORGANIZATION FOR THE CURRENT FINANCIAL YEAR
• PROJECT BUDGET
• LIST OF ORGANIZATION’S OFFICERS AND DIRECTORS AND THEIR OCCUPATIONS
• COMPLETED APPLICATION CODING SHEET

INDICATE YEAR OF YOUR MOST RECENT (IF ANY) GRANT APPLICATION TO OR FUNDING FROM THE BETTERMENT FUND*____________
*No more than one (1) Grant Application will be considered during any 12 month period, and no new Grant Application will be considered while any previous Betterment Fund grant commitment to the organization is pending, or sooner than 10 months after the last installment payment on any Betterment Fund Grant received. Grants may be deferred pending submission of satisfactory Final Report on previous Grant(s)

TOTAL GRANT REQUEST: $_______________________
Allocation:
FIRST YEAR: $ _____________
SUCCESSIVE YEARS (IF ANY): $______________ X _______ # OF YEARS

The Betterment Fund Proposal Codes

Please help us categorize your grant proposal by circling the ONE appropriate code under each of the three following headings (I, II, III.) Many grant proposals fit into more than one category; please choose the one you think is most appropriate. Please note that the listing of a category does not necessarily indicate that the Betterment Fund is currently making grants in that category.

I. Geographical Area Served (circle only ONE):

II. Type of Support (circle only ONE):
Capital Purchases or Endowment
Operating Support / Projects / Programs

III. Program Areas (circle only ONE Program Area and One Subgroup of it):