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SRD Board Members Scott Aune Sarah Mikesell Growney Matt Hall Dan Haman Tony Hult Jacob Ivanoff Melissa Allen Jake Fulkerson Alan Rosenbaum Dossie Overfield Stan Wolz Shoshone Recreation District 1402 Heart Mountain Street PO Box 1531 Cody WY 82414 (307) 527‐3484 [EMAIL REDACTED] Rick Manchester Director (307) 527‐3485 [EMAIL REDACTED] Jo Selk Administrative Secretary Shoshone Recreation District (SRD) Is Seeking Proposals for Funding from Groups & Organizations within Park County School District 6 Boundaries Grant Application • FY 2016‐2017 Application Deadline‐‐Friday, April 1, 2016 Recreation oriented, non‐profit organizations within the boundaries of Park County School District 6 are invited to apply for funding. Grant applications are due Friday, April 1, 2016 – 4:00 PM, email submissions are acceptable. Grant money can be spent July 1, 2016 – June 30, 2017. The Shoshone Recreation District supports healthful and creative recreation programs, facilities and activities to enrich the lives of the residents of Park County School District 6. To be considered for a grant, please provide the following detailed information relating to your request and organization: 1. Submit a completed application form with relevant attachments before deadline. Applications are available on the City of Cody website http://www.cityofcody‐wy.gov/index.aspx?NID=175. Send, email or deliver: Shoshone Recreation District, PO Box 1531, Cody WY 82414 [EMAIL REDACTED], [EMAIL REDACTED] Call and confirm email submittals made it through City spam software Or deliver to: Cody Recreation Center, 1402 Heart Mountain Street Attention: Shoshone Recreation District Questions: 307‐527‐3484 Rick Manchester 307‐527‐3485 Jo Selk 2. Required Attachments: Current year organizational budget summary Most recent balance sheet and income statement 3. Applicants will be notified by mail, telephone or e‐mail after the board has reviewed all applications. At the discretion of the SRD Board, group presentations and interviews may be required. If a presentation is required, the organization will be contacted and presentations will be scheduled on the evening on Wednesday or Thursday, April 13 or 14, 2016, time and day TBD. 4. There will be a voluntary grant writing workshop on Wednesday, March 23, 6:00‐7:30 PM at the Rec Center if you need assistance completing your application. RSVP required. 5. Organizations that receive a grant will be asked to attend a voluntary non‐ profit board training and orientation in May. Information will be announced later. ---PAGE BREAK--- Shoshone Recreation District Grant Application Form FY2016‐2017 (Please type or print legibly) Organization Requesting Funding Is your organization incorporated as a non‐profit organization under WY State Law and IRS status? Type of non‐profit organization‐‐please explain: Non‐profit with IRS 501 3 STATUS ―Number: Other (please indicate): How long has your organization been in existence? Years Is this your first year completing a SRD application for funding? Is your organization within Park County School District 6 Boundaries? Mailing Address Contact and Authorized Representative (officer) Name & Title Phone(s) E‐Mail Secondary Contact and Representative (officer) Name & Title Phone(s) E‐Mail 1. List of Current Board Members Name (Please Print) Name Grant amount being requested: 1 of 5 ---PAGE BREAK--- 2. What recreation services does your organization provide? Please explain. 3. Do you have plans to financially support your organization without this grant? Please explain. 4. How is the organization prepared for an unexpected loss of revenue? Please explain. 5. Summary of Organizations Budget Annual Budget Expenses Revenue‐‐Registration, entry fees, sponsor, fundraisers, etc. 6. Purpose of funding or how will the grant be used: Total requested amount by item listed in left column. Purchase Equipment (explain) Equipment $ Materials and Supplies (explain) Materials $ 2 of 5 ---PAGE BREAK--- General Liability Insurance? Insurance $ Field or facility fees? (explain) Field or facility fees $ Other (explain) Other $ Is it feasible to purchase equipment/materials in Park County School District 6? If no, explain. Will any of the funding requested be used for grant matching? If yes, attach a list of grantor names, project description, grant amounts and matching requirements. Use additional sheets if necessary. If yes, explain. If your organization received SRD grant funds in the past, how were the funds used and was it successful? If yes, explain. 3 of 5 ---PAGE BREAK--- 7. Does your organization make scholarships available to participate in your program? If yes, explain. 8. Is your program open to participants with all skills and abilities? If no, explain. 9. Is there a selection or tryout process that limits the number of individuals involved that can participate? If yes, explain. 10. Number of Park County School District 6 Residents and Non‐Residents Served Estimated number of Park County School District 6 Residents and Non‐Residents Served Number of Program Days Age Groups Served Participant Registration Fees Per Participant 2016 This Year Projected Residents Non‐Residents 2015 Last Year Actual Residents Non‐Residents 4 of 5 ---PAGE BREAK--- 11. Financial Resources: Attach separate list if additional space is needed. Source (Name of funding sources) Amount of Funding Requested / Approved Funding Use Example: Park County Parks & Rec Board $5,000 ― Approved Football Equipment Example: Sponsor Name $5,000 ― Requested Uniforms Example: Cash Balances/Financial Reserves of Organization Requesting $5,000 ― Approved Soccer Goals TOT $ 12. Authorization: I certify that all of the information provided on this application is true and complete to the best of my knowledge. Liability insurance coverage is also required for the Organization identified on this application. I understand that if asked by an authorized official of the Shoshone Recreation District, I agree to give proof of the information that I have given on this application and to provide certificate of liability insurance, coverage period and type of coverage. Your group/organization agrees to indemnify the Shoshone Recreation District of any liability associated with the use of such funds and certifies that this grant request has been approved by your governing board(s). Date: Organization Requesting Funding: Authorized Representative’s (Officer) Signature: Title: 5 of 5 SIGN