2019 Thrift Shop Grant Application
The mission of Great Smokies Health Foundation is to improve health care in Jackson, Swain, Macon, and Graham Counties in western North Carolina.
As the Foundation further examines health issues and evidence based practices to improve the health and wellness of our service area, the Board of Directors has decided to continue the “Thrift Shop Grant Program”. This program is funded by the profits of the Jackson and Swain County Thrift Shops and focuses on Jackson and Swain counties. Thrift Shop Grants are intended to be one time grants of up to $5,000 for programs or projects that will impact the health and wellness services of Jackson and Swain County and will be awarded in September 2019.
Non-profits, governmental entities, and educational institutions in the specific service area of Jackson and Swain County are invited to apply for the Foundation’s fifth round of grant making through the 2019 Thrift Shop Grant Program.
- Grant requests should not exceed $5000.00.
- Funding must be committed within one year of receipt of grant funds
- All responses to the application form must be contained within the space provided and be typed not hand written with a font of 12 point or larger with ¾ inch margins.
- Completed applications must be limited to a maximum of three (3) pages in length.
- Applications that exceed the maximum length or that are incomplete will not be considered.
- All requested information and documentation must be attached.
- Deadline for receipt of the completed applications, either hand delivered to the Foundation Office, (1134A Skyland Drive, Sylva) E-mailed to: firstname.lastname@example.org, with hard copy to follow, or received in P.O. Box 176, Sylva NC 28779, by 4 PM on Friday, July 26, 2019.
The Foundation will not accept or consider applications that support the following activities or requests:
- Requests for medical /health research or non-medical/non-health related services
- Requests for individuals, fundraisers, dinners, or faith based organizations for religious purposes.
- Requests that supplant or substitute for existing funding.
To receive an application, answer questions regarding the grant program, application questions, and/or application process contact Wanda Belcher, Foundation Assistant at (828) 507-2270 or E-mail: email@example.com.
P.O. Box 176, Sylva NC 28779
1134A Skyland Drive
Applications due by July 26, 2019 at 4pm
(Please limit answers to space provided, application not to exceed 3 pages)
Organization Name: _____________________________________________________
Organization Tax ID #:___________________
Contact Full Name: _____________________________________________________
Contact Title: _____________________________________________________
Mailing Address: _____________________________________________________
Email Address: _____________________________________________________
Contact Phone No.: _____________________________________________________
Project Title: _____________________________________________________
Requested Amount: $___________________
Organization Type: _____Non-Profit ______ Governmental ____ Educational
County Served by Project: ________ Jackson ______ Swain _____ Both
- Copy of IRS 501 (c) (3) Determination Letter
- Organizational Budget for Current Operating Year
- Most recent IRS Form 990
- List of Board members involved in project and their role(s) in the project, if applicable.
- List of Staff members involved in project and their role(s) in the project.
- Project Budget
1. Describe briefly the mission of your organization and the population it serves?
2. Provide a brief overview about your organization’s programs and operations and how they relate to the health of local community?
3. Is this a new Project or a Continuing Project?
_______Continuing. If continuing, explain how the project has been funded in
the past and why new funding from our agency is needed?
4. Describe the proposed Project in detail and what impact it will have on health care in the targeted communities. Include proposed number of individuals to be served.
5. Describe how this will this impact(s) be measured?
6. Provide a detailed budget of the project indicating both revenues and expenses. Please include how the requested funds will specifically be used. Include and identify any additional funding requests that you have made or will make to other funders for the same program.
7. If funding is not received, what impact will it have on the project/program you are requesting funding for?
8. What is the 2019 Annual Operating Budget for your Department or organization? $______________
Signature of Project Manager: ______________________________ Date: __/___/19
Authorized Applicant Signature: _____________________________ Date: __/___/19
(Executive Director/School Board Principal/Government Agency Director)