J.B. Chambers Grant Application

"*" indicates required fields

Section A: Organization Information

Name*

Email*

Address*

City*

State

Zip*

Mailing Address

Project Name

Grant Is On Behalf Of:*

Individual

Organization

Date organization formed:*

State Of Incorporation/Formation

Federal Tax Identification Number*

Section B: Type Of Organization

Select The Appropriate Organization Type:

Please Describe*

Has This Organization Been Formally Granted Tax-Exempt Or Non-Profit Status By The Internal Revenue Service?

Please attach a copy of the most recent Determination Letter issued by the I.R.S. District Director:*

Max. file size: 50 MB.

Please attach a copy of the most recently-filed Form 990, Return of Organization Exempt from Income Tax:*

Max. file size: 50 MB.

Section C: Additional Information

Copy Of By-Laws:

Max. file size: 50 MB.

Copy Of Current Listing Of Board Of Directors Or Officers, Or Other Details Regarding Governing Body

Max. file size: 50 MB.

Copy Of Most Recent Financial Statements

Max. file size: 50 MB.

Please Select Which Applies To Your Uploaded Financial Statements: *

Has This Organization Applied To The Jb Chambers Foundation For A Grant In The Past?

When?*

Section D: Information Regarding Current Grant Request

Amount Of Request:

Please Attach A Copy Of Your Project Budget:*

Max. file size: 50 MB.

Type Of Request:*

Provide details as well as funding sources for continuance of expanded program or services: **

List potential future sources of funds and indicate level of commitment:*

Please Explain:*

Distribution Requirements:*

Please provide details:*

Please Provide A Narrative That Describes, In Specific Terms, The Proposed Use Of Funds.

Are There Other Funds Available To Your Organization Whose Receipt Is Dependent Upon Approval Of This Grant Request?*

Source:*

Is This A Request For A Matching Grant?*

Please identify the sources and matching ratios (i.e.: two for one, three for one, etc.):*

How Many Ohio County, Wv/West Alexander, Pa Youth Is The Grant Serving?*

Section E: General Information | Request Prepared By:

Name:

Title:*

Phone:

Are there additional person(s) authorized to discuss this request?*

How Many?

Name(1)*

Title(1)*

Phone(1)*

Name(2)*

Title(2)*

Phone(2)*

Name(3)*

Title(3)*

Phone(3)*

Section F: Certification

By typing your name(s) below, I/we hereby certify that the information provided on this application form is true and accurate to the best of my/our knowledge and belief.*

Contact Us to Apply for Funding

Reading through the application is recommended as it can provide better comprehension of the grant process, but applicants can contact us for any queries regarding unique situations they may encounter. We look forward to hearing from you.