COVER PAGE
Federal Tax ID Number
Organization name
Program title
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Title
E-Mail Address
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Fiscal Agent Name & Address (if applicable)
Fiscal Agent Contact Person Name & Title (if applicable)
GRANT APPLICATION QUESTIONS
Provide a brief history and purpose of the organization. (If your organization is affiliated with Catholic Health East, describe your affiliation here).
Geographic area served (i.e. county, city, neighborhood)
Population served (i.e. children, elderly, homeless)
Describe the need for your program. How did you determine this need?
Describe the program for which you are seeking funds. Please include information such as what you will do, who you will serve, what you hope to accomplish, and your organiztion's experience working with the target population.
Identify how your program meets the ACOR Priority Criteria listed on page four.
BUDGET INFORMATION
Total organization budget
Total program budget
Total requested from Allegany Franciscan Ministries
Funding sources obtained for this project
Funding sources requested for project: status pending or denied
Have you applied to St. Elizabeth Mission Society for funding this program? (CHE-affiliated applicants excluded)
Complete the table below estimating the general line items in the budget. Briefly describe the specific expenses within each line item.
Budget Category/Line Item Program Budget AFM Funding Requested
(salaries, training, insurance, purchased services)
Other
Remember to submit your Affiliation Form and your IRS 501 (c)(3) determination letter by either scanning the documents and then emailing them to grants@afmfl.org or by faxing them to 727-507-8557. Click the button below to submit your ACOR grant application.
