Operation Round-Up Grant Request Form - JCREMC

Operation Round-Up Grant Request Application

Grant Request Application

Grant applications are available twice annually in Spring and Fall. The Spring application period is April 1-30 and the Fall application period is October 1-31.

Geographic Focus
Operation Round-Up® provides funding to approved eligible applicants within communities JCREMC serves.

Grant Cycles
Grant applications are accepted only in the months of April and October. Grant applications are due the last working day of April and October. The advisory board typically will meet in May and November to review applications and award grants.

Categories of Assistance

Community Service
- Programs, projects and organizations that contribute to the community’s overall quality of life with emphasis on public safety, health, self-sufficiency and basic human needs. Also, programs and projects that enhance the cultural environment of our community.
Education and Youth
- School and academic enrichment programs and projects that promote youth wellness and/or programs and projects designed to combat critical social problems affecting youth.
  Environment
  Community based environmental quality, natural resource, and recycling education programs.
Applicant Eligibility
- Contributions will generally be made primarily to non-profit organizations, government entities, school districts or colleges that have been granted tax-exempt status by the Internal Revenue Service. The organization must contribute to the entire community’s health and/or welfare and the services must be nondiscriminatory in nature.

Evaluation Factors
The following factors will be considered in the evaluation for all funding requests:

Potential benefit to residents of the JCREMC service area and surrounding communities
Number of persons affected by the project
Level of community support of the project and the organization requesting the funds
Fiscal and administrative capability of the organization requesting the funds
Results that are predictable and can be measured and evaluated

Completing the Application

Complete all pages of the application form.
Be sure to sign the application.
A copy of the organization’s most recent fiscal year’s financial statement must be attached. If the organization has an independent audit, a copy of that report should be attached.
A copy of the organization’s non-profit status from the IRS must be included.
A copy of the requesting organization’s current fiscal budget should be attached. A one-page budget outlining the project of this request must be attached.
If you are requesting specific items, please attach a written vendor quote with a line item break down for each item. Specifications of the items are requested.

Submitting the Application

Submit the application electronically below or print hard copy and mail to:
Operation Round-Up®
750 International Dr. (in person)
P.O. Box 309 (mail)
Franklin, IN 46131

Direct questions to roundup@jcremc.com or 317-736-6174.

Legal Name of Organization*
Address*
Street Address Address Line 2 City State ZIP Code
Grant Request Contact Person*
Title*
Phone*
Email*
Is the organization tax exempt?*
- Yes
- No
A copy of your IRS status and federal ID # (EIN) must be submitted.
EIN
Is the organization audited?*
- Yes
- No
Fiscal year end date:*
Month
Day
Year
Number of full-time employees:*
Year the organization formed:*
List the board of directors members, officers, or trustees, and their contact information:*
Amount of grant funds requested:*
Please enter a number less than or equal to 5000.
(Maximum $5,000.00)
Total project budget:*
Date funds are needed:*
Month
Day
Year
Other sources being asked for funds for this project:*
If none, respond "N/A."
Other sources already providing grant funds for this project (endowment, reserve, or other):*
If none, respond "N/A."
Has your organization previously applied to Operation Round-Up?*
- Yes
- No
Organizations may apply multiple times, regardless of whether funds were previously received.
Results of previous Operation Round-Up applications:*
If none, respond "N/A."
Briefly describe the project for which you are requesting a grant:*
What cash or in-kind contributions is your organization making to this project?*
Describe the number of people who would benefit from this project, who they are, and the type of impact it will have on them:*
What is the number of individuals, families, and/or groups served by your organization in the past year?*
Describe the outcome you expect from this program and how you plan to measure it:*
What will happen to this project if we are unable to grant the amount requested?*
If you have requested multiple items in this grant, please prioritize the items so that if only a portion of your request may be granted, items covered under that portion can be easily identified:*
Use this space to provide more specific details about your project that would be helpful to the committee:*
References
List three references not affiliated with JCREMC, its subsidiaries, or the JCREMC Community Fund.
Name*
First Last
Phone*
Affiliation with your organization:*
Name*
First Last
Phone*
Affiliation with your organization:*
Name*
First Last
Phone*
Affiliation with your organization:*
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Upload File(s) listed below:*
Drop files here or
Max. file size: 256 MB, Max. files: 6.
1) A copy of the organization’s most recent fiscal year’s financial statement must be attached. If the organization has an independent audit, a copy of that report should be attached.
2) A copy of the organization’s non-profit status from the IRS must be included.
3) A copy of the requesting organization’s current fiscal budget should be attached. A one-page budget outlining the project of this request must be attached.
4) If you are requesting specific items, please attach a written vendor quote with a line item break down for each item. Specifications of the items are requested.
Signature*
By clicking "Yes, I agree," you certify that the information contained in this statement is for the purpose of obtaining funding from the JCREMC Community Fund on behalf of the organization listed on page one. The undersigned is acting as an agent for the organization for the purpose of this application. The undersigned hereby states that all information provided on this form is true and accurate on the date signed and that the JCREMC Community Fund may consider this information as continuing to be true and hereby authorized to make any and all inquiries of directors, employees, clients, and others affiliated with the organization to verify accuracy of statements and requests made herein. The undersigned hereby states that if the JCREMC Community Fund grants funds for the request contained herein, that those funds shall only be used for the purpose stated in this application. Should the organization have grant funds distributed to it that it cannot for any reason spend on the purpose stated in this application, such funds shall immediately be returned to the JCREMC Community Fund. If funding is received, we hereby grant JCREMC Community Fund permission to publicize such grant through mediums it determines proper. Such publicity may include photographs, video, audio recordings and written statements. Such publicity shall be about the grant itself and the project. Financial and other organizational data shall not be included in the publicity without written consent of the organization. The JCREMC Community Fund shall also maintain the right to request an audited financial statement of the organization that would cover the year the grant was received and/or expensed. If an audit is not conducted by the organization, the Fund shall be provided with a copy of the board approved financial statement for the fiscal year including the grant expense.
Yes, I agree
Name of Organization:*
Name of representative:*
First Last
Date
MM slash DD slash YYYY
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Email
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Operation Round-Up Grant Request Application

Grant Request Application

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