THE MILFORD NATIONAL CHARITABLE FOUNDATION INC.

GRANT APPLICATION

ORGANIZATIONAL NAME:___________________________________________________

ADDRESS:___________________________________________________________________

TELEPHONE NUMBER:_______________________________________________________

DOES YOUR ORGANIZATION QUALIFY AS A (501-C3) TAX EXEMPT CHARITABLE ORGANIZATION?  PLEASE SUBMIT COPY OF YOUR APPROVAL.

WHAT IS THE PRIMARY FUNCTION OF YOUR ORGANIZATION?

WHAT IS YOUR ORGANIZATION’S PRIMARY SERVICE AREA?

GIVE AN EXPLANATION OF WHY YOUR ORGANIZATION IS SEEKING FUNDING
AND HOW THIS FUNDING WILL IMPACT THE COMMUNITIES IN THE GREATER MILFORD AREA?

DOES YOUR ORGANIZATION AGREE TO PREPARE AND SUBMIT AN EVALUATION
AT THE COMPLETION OF THE GRANT, SUMMARIZING THE RESULTS ACHIEVED
WITH THE ASSISTANCE OF THE FOUNDATION’S FUNDS?     YES______    NO______

ALSO: PLEASE SUBMIT THE FOLLOWING:

1)	A COPY OF YOUR MOST RECENT FINANCIAL STATEMENTS.
2)	A LIST OF YOUR ORGANIZATION’S VOLUNTEER BOARD OF DIRECTORS AND A BRIEF NARRATIVE THAT DEMONSTRATES IT ASSUMES AN ACTIVE AND RESPONSIBLE ROLE IN THE ORGANIZATION’S ACTIVITIES.
3)	EVIDENCE OF ADEQUATE ADMINISTRATIVE SAFEGUARDS FOR HANDLING FUNDS.
4)	COPIES OF ANY POLICIES TO INSURE COMPLIANCE WITH ALL APPLICABLE FEDERAL AND STATE LAWS AND REGULATIONS.
5)	INCLUDE ANY SUPPORTING DOCUMENTATION IF YOU ARE SERVING THE LOW TO MODERATE INCOME POPULATION.
6)	PLEASE RETURN THE APPLICATION TO: THE MILFORD NATIONAL CHARITABLE FOUNDATION, INC. C/O THE MILFORD NATIONAL BANK ATTN: MARKETING 300 EAST MAIN STREET MILFORD, MA 01757

DATE SUBMITTED:_______________________

CONTACT PERSON:__________________________________________________________

TITLE: ___________________________________________________________

SIGNATURE: ___________________________________________________________

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