Funding Application
Organization Full Legal Name:
Address:
Phone:
City:
State:
Zip:
Fax:
Exec. Director/CEO:
Signature:
Title:
Phone:
Fax:
E-Mail Address:
Web URL:
United Way Funded:
501(c)(3) Public Charity
Tax ID Number of the Organization Applying:
Amount Requested $:
Total Project Cost $:
Organization’s annual budget $:
(for the current year)
Has the organization applied to the Najim Family Foundation in the past and been declined?
If yes, when? (This includes all organizations, for any and all requests made to the foundation, regardless if funding received for one request and a decline for a different request.)
Harvey E. Najim Family Foundation Priorities
Select ONE area only.
Please provide the percentage of each group below that will be served by the project in which funds are being requested. Do not leave any area blank. If that specific group will not be served, include zero or N/A. The percentage should total 100%.
(Example: If more than one group is affected, divide the percentage appropriately among those affected or in some instances the project may only affect one group, therefore the entire percentage will be applied to that group.)
A. Population Served Age:
%
%
%
100
%B. Population Served Ethnicity:
%
%
%
%
%
%
100
%C. City Council District for Which Children are Being Served:
Project Title:
Project Description:
(Copy and Insert the “To Support” sentence from Invitation email received from NFF)
(Describe in detail the project the funds are being request for – may include goals, issues, or needs the project will address, individuals impacted, expected results). This section will expand and if additional space is required, organization may add no more than 1 additional sheet.
Children impacted:
Organization’s Mission:
(For Project being Requested): Funding sources and amounts, pending and committed: Insert as table and total each Pending & Committed columns.
REQUIRED: (This section must include the names & dollar amounts of other funding sources & foundations, pending and committed for this specific project. Application will be declined if the name and dollar amount is not included.) Rows can be add to table below (if needed).
Other funding sources and amounts, pending and committed not specific to this request: Insert as table and total each Pending & Committed columns.
REQUIRED: (This section must include the names & dollar amounts of other funding sources & foundations, pending and committed. Application will be declined if the name and dollar amount is not included.) Rows can be add to table below (if needed).
What percentage of your board contributes financially to the organization?
How are board members expected to participate in your organization?
(financially and other roles)
Plans to sustain project beyond the term of this request:
Evaluation:
Contact:
Title:
Phone:
E-Mail:
Date:
Evaluation Plan:
(1 page)
(1 page) – Must list all current assets (cash etc.) and all current liabilities otherwise application will be declined.
(2 pages) *It is okay to use the last fiscal year. *If not available, submit the last FY Income Statement
