Project Summary Pg. 14 Required Pg.______ Project Selection Pg. 15 Required Pg.______ Criteria Match Pg. 22 Required Pg.______ Certification Form Additional Checklist for Nonprofit Applicants Nonprofits must complete the checklist below and submit with the application packet. documents will be used in evaluating Criterion #5, Organizational Capacity. Do not send letters of support or other supplementary materials. Application Item If not Application Item Enclosed? enclosed, will Packet Circle submit by? Page # Y (Yes) (must be within 60 days of or deadline) N (No) Letter of Determination from the Internal _______ Revenue Service indicating Y / N Pg.______ date 501(C)(3) status _______ Articles of Incorporation Y / N Pg.______ date _______ Mission statement Y / N Pg.______ date First two pages of the nonprofit’s most _______ Y / N Pg.______ recently filed federal 990 Form date _______ Balance sheet showing assets and liabilities Y / N Pg.______ date for most recent FY Income statement showing revenue and _______ expenditure projections for the next Y / N Pg.______ date calendar or fiscal year
Project Summary Pg. 14 Required Pg.______ Project Selection Criteria Pg. 15 Required Pg.______ Match Certification Form Pg. 22 Required Pg.______ Additional Checklist for Nonprofit Applicants Nonprofits must complete the checklist below and submit with the application packet. documents will be used in evaluating Criterion #5, Organizational Capacity. Do not send letters of support or other supplementary materials. Application Item Item Enclosed? Circle Y (Yes) or N (No) If not enclosed, will submit by? (must be within 60 days of deadline) Application Packet Page # Letter of Determination from the Internal Revenue Service indicating 501(C)(3) status Y / N _______ date Pg.______ Articles of Incorporation Y / N _______ date Pg.______ Mission statement Y / N _______ date Pg.______ First two pages of the nonprofit’s most recently filed federal 990 Form Y / N _______ date Pg.______ Balance sheet showing assets and liabilities for most recent FY Y / N _______ date Pg.______ Income statement showing revenue and expenditure projections for the next calendar or fiscal year Y / N _______ date Pg.______