Financial Capacity and Review Scoring Form Applicant Information Over 21 yrs. 10–20 yrs. 0-9 yrs. How long has your organization been doing business? 3 pts. 1pt 0 pts. Number of Employees: Date of organization’s 501(c)3 status with the IRS: Organizations Total Revenue: $ Grant Request: $ Grant request is % of total revenues: 24% or less 25-49% 50-74% 75% or more (total revenue divided by grant request) 4 pts. 3 pts. 2 pts. 1 pt. Fiscal year (start/end): <5 3-5 1-2 How many different funding sources does the total revenue come from? 3 pts. 2 pts. 0 pts. Does the organization have clearly stated and current administrative, fiscal and Yes No programmatic policies and operating procedures in accordance with state and federal 2 pts. 0 pts. statutes? Yes No Not Sure Does the organization have Directors and Officers Insurance that covers the Board 0 pts. and applicable senior managers? 2 pts. 0 pts. Accounting System Which of the following best describes your Manual Automated Combination accounting system? 1 pt. 3 pts. 2 pts. organization’s Yes If the organization has multiple grants funding a program or activity, does No Not Sure the accounting system tie expenditures to individual grant line items? 2 pts. 0 pts. 0 pts. Are time activity records kept for all employees who receive funding from Yes No Not Sure multiple sources including the Executive Director? Are these signed by their 2 pts. 0 pts. 0 pts. supervisor? Yes Does the accounting system have a way to identify over-spending of grant No Not Sure funds? 2 pts. 0 pts. 0 pts. Financial Statements Yes No Not Sure When was the last audit of the organizations financial statements 2 pts. 0 pts. 0 pts. completed? Annual? Name of Accounting Firm: Yes No Most recent board-reviewed financial statements Date: 2 pts. 0 pts. Describe existing debt Yes No Has any debt been incurred in the last 12 months? 0 pt. 1 pt. Yes No What was the reason for the new debt? Reasonable? N/A 1 pt. 0 pts. What is the funding source for paying back the new debt? N/A
Financial Capacity and Review Scoring Form Applicant Information How long has your organization been doing business? Over 21 yrs. 3 pts. 10–20 yrs. 1pt 0-9 yrs. 0 pts. Number of Employees: Date of organization’s 501(c)3 status with the IRS: Organizations Total Revenue: $ Grant Request: $ Grant request is % of total revenues: (total revenue divided by grant request) 24% or less 4 pts. 25-49% 3 pts. 50-74% 2 pts. 75% or more 1 pt. Fiscal year (start/end): How many different funding sources does the total revenue come from? <5 3 pts. 3-5 2 pts. 1-2 0 pts. Does the organization have clearly stated and current administrative, fiscal and programmatic policies and operating procedures in accordance with state and federal statutes? Yes 2 pts. No 0 pts. Does the organization have Directors and Officers Insurance that covers the Board and applicable senior managers? Yes 2 pts. No 0 pts. Not Sure 0 pts. Accounting System Which of the following best describes your organization’s accounting system? Manual 1 pt. Automated 3 pts. Combination 2 pts. If the organization has multiple grants funding a program or activity, does the accounting system tie expenditures to individual grant line items? Yes 2 pts. No 0 pts. Not Sure 0 pts. Are time activity records kept for all employees who receive funding from multiple sources including the Executive Director? Are these signed by their supervisor? Yes 2 pts. No 0 pts. Not Sure 0 pts. Does the accounting system have a way to identify over-spending of grant funds? Yes 2 pts. No 0 pts. Not Sure 0 pts. Financial Statements When was the last audit of the organizations financial statements completed? Annual? Yes 2 pts. No 0 pts. Not Sure 0 pts. Name of Accounting Firm: Most recent board-reviewed financial statements Date: Yes 2 pts. No 0 pts. Describe existing debt Has any debt been incurred in the last 12 months? Yes 0 pt. No 1 pt. What was the reason for the new debt? Reasonable? Yes 1 pt. No 0 pts. N/A What is the funding source for paying back the new debt? N/A
Financial-Capacity-and-Review-Scoring-Form-Template_tcm36-206805.docx