Committee is chaired by the Treasurer. Two (2) copies of Submit by Governing to : *Include Board’s One (1) county and strategic plan Grant One (1) of program type Application and each policy: in subject including sustainability conflict of line. Include signatures and interest, plan. all a clear confidentiality, attachments attachment in a single GRANT APPLICANT INFORMATION title (e.g. email. Wake DV organizational Organization type: Nonprofit Corporation Local Governmental Entity Grant code of DUNS # if applicable (Data Universal Numbering System): Application). conduct, Organization’s fiscal year: January - December July - June October September – internal Year the organization was incorporated: controls, Year the organization obtained nonprofit status: recordkeeping Month and year DV or SA program began operations: (for electronic and manual Is program a subsidiary of another organization? Yes No files), and Current Executive Director: As of whistleblower. Name: Identify each E-mail Address: policy clearly Telephone Number: in attachment Current Program Director (if applicable): As of titles. Please Name: note: The E-mail Address: NCCFW/YI Telephone Number: does not Administrative Office Physical Address: accept Mailing Address (if different from above): responsibility for the Days and Hours of Operation: sufficiency or Administrative/Business Line Phone: Fax: the legality of DV or SA Shelter/Program Physical Address (optional): the policies Mailing Address (if different from submitted. Days and Hours of Operation: Sample policy Program Office/Facility Phone: Fax: Crisis Line: templates are Organizational Website Address: available in Please indicate if the agency providing program services funded by the NCCFW/YI: the Grants Owns the property where services will be provided: Yes No section of the Leases space where services will be provided: Yes No NCCFW/YI Utilizes donated space where services will be provided: Yes No website. Does your program multi-lingual services? Yes No If so, please indicate language(s):
Committee is chaired by the Treasurer. Two (2) copies of Governing Board’s strategic plan and sustainability plan. Submit by to : *Include county and program type in subject line. Include all attachments in a single email. One (1) Grant Application including signatures and a clear attachment title (e.g. Wake DV Grant Application). One (1) of each policy: conflict of interest, confidentiality, organizational code of conduct, internal controls, recordkeeping (for electronic and manual files), and whistleblower. Identify each policy clearly in attachment titles. Please note: The NCCFW/YI does not accept responsibility for the sufficiency or the legality of the policies submitted. Sample policy templates are available in the Grants section of the NCCFW/YI website. GRANT APPLICANT INFORMATION Organization type: Nonprofit Corporation Local Governmental Entity DUNS # if applicable (Data Universal Numbering System): Organization’s fiscal year: January - December July - June October – September Year the organization was incorporated: Year the organization obtained nonprofit status: Month and year DV or SA program began operations: Is program a subsidiary of another organization? Yes No Current Executive Director: As of Name: E-mail Address: Telephone Number: Current Program Director (if applicable): As of Name: E-mail Address: Telephone Number: Administrative Office Physical Address: Mailing Address (if different from above): Days and Hours of Operation: Administrative/Business Line Phone: Fax: DV or SA Shelter/Program Physical Address (optional): Mailing Address (if different from Days and Hours of Operation: Program Office/Facility Phone: Fax: Crisis Line: Organizational Website Address: Please indicate if the agency providing program services funded by the NCCFW/YI: Owns the property where services will be provided: Yes No Leases space where services will be provided: Yes No Utilizes donated space where services will be provided: Yes No Does your program multi-lingual services? Yes No If so, please indicate language(s):
NCCFWYI%202017-2018%20Grant%20Application%20for%20NEW%20Applicants%20as%20of%20March%202%202017.docx