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1 We are pleased to offer your agency/group this opportunity to apply for a 2014 Helping Hands Grant. Please take a moment to review the Helping Hands Program Guidelines enclosed with the letter you received or on line at: www.anaheimcommfound.org. Be specific as possible when completing the information in this grant application. Incomplete applications will not be considered. An original and five copies of the grant application are to be postmarked or submitted on or before March 14, 2014 to: Anaheim Community Foundation - 2014 Helping Hands Grants, 200 S. Anaheim Blvd. #433, Anaheim, CA 92805. AGENCY/GROUP INFORMATION: Name: Address: City: Zip: Telephone: Email: Contact Person: Title: Contact Phone Number: Contact’s Email: PROGRAM INFORMATION: Program Name: Program Contact Person:(If different than above) Telephone Number: Email: Amount Requested for this Program: $ PROGRAM REVENUE SOURCES: Name of Revenue Source: Actual FY2012/2013 Projected FY2013/2014 Proposed FY2014/2015 $ $ $ $ $ $ $ $ $ $ $ $ ANAHEIM COMMUNITY FOUNDATION HELPING HANDS GRANT AWARDS RECEIVED BY YOUR AGENCY: 2013 Amount: $ 2012 Amount: $ 2011 Amount: $ Have not received Helping Hands Funding previously for any programs. WHAT WILL THE HELPING HANDS FUNDS BE USED FOR – Be as specific as possible: ANAHEIM COMMUNITY FOUNDATION HELPING HANDS GRANT APPLICATION ---PAGE BREAK--- 2 ANAHEIM COMMUNITY FOUNDATION 2014 HELPING HANDS GRANT APPLICATION TARGET POPULATION: What is the target population your program will serve? Indicate the number of Anaheim residents you served and expect to serve with this program. Actual FY 2012/2013 Projected FY 2013/2014 Proposed FY 2014/2015 Percentage of Total Clients: Percentage of Total Clients: Percentage of Total Clients: PROGRAM STATISTICS Item Actual FY 2012/2013 Projected FY 2013/2014 Proposed FY 2014/2015 Number of Full Time Employees: Number of Part Time Employees: Total Salaries and Benefits: Total Operating Expenses: NON PROFIT INFORMATION: Is your Agency Incorporated in California as a Non Profit Corporation? YES Date of Incorporation: Federal ID No: State ID No: No If your organization supports, or is sponsored by a non-profit organization, please provide the name of the organization(s): SUMMARY OF ORGANIZATIONAL GOALS: DESCRIBE THE AGENCY’S HISTORY AND EXPERIENCE IN PROVIDING THE PROPOSED SERVICES: ---PAGE BREAK--- 3 ANAHEIM COMMUNITY FOUNDATION 2014 HELPING HANDS GRANT APPLICATION VOLUNTEERS: WHAT IS THE AGENCY’S EXPERIENCE IN UTILIZING VOLUNTEERS? HOW WILL YOUR AGENCY UTILIZE VOLUNTEERS IN THE PROPOSED PROGRAM? WHAT ARE THE AGENCY’S PLAN TO SOLICITE OTHER FUNDS FOR THIS PROGRAM (i.e. fees, donations, fundraisers, etc.)? AGENCY’S BOARD OF DIRECTORS: TITLE NAME CONFIRMATION BY CHAIRMAN/PRESIDENT OF BOARD OF DIRECTORS: By my signature below, I confirm that the above information given is to the best of my knowledge true and correct. I also confirm that the Board of Directors of this organization have full knowledge of this proposal and have approved this grant submittal. If funding, in any amount, is allocated to your agency or group, those funds will be used to provide the program(s)/service(s) described in this grant application. Further, I assure that my agency/group will file the annual report to the Anaheim Community Foundation as required. Signed: Title: Printed Name: Date: