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SRD Board Members Scott Aune Sarah Mikesell Growney Matt Hall Dan Haman Tony Hult Jacob Ivanoff Melissa Allen Dossie Overfield Alan Rosenbaum Dave Treick 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 2014/2015 Application Deadline • Friday, April 4, 2014 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 4, 2014 – 4:00 PM, email submissions are acceptable. Grant money can be spent July 1, 2014 – June 30, 2015. The Shoshone Recreation District has a common goal of providing healthy and creative recreation programs, facilities and activities to meet the needs of the District residents. To be considered for a grant, non-profit recreation oriented organizations should provide the following detailed information relating to your request and organization: 1. Submit a completed application form with relevant attachments before Friday, April 4, 2014 – 4:00 PM. Applications are available on the City of Cody website http://www.cityofcody- wy.gov/index.aspx?NID=175. Send to: Shoshone Recreation District PO Box 1531 Cody WY 82414 Or Deliver or email to: Cody Aquatic and Recreation Center 1402 Heart Mountain Street Attention: Shoshone Recreation District Rick Manchester or Jo Selk [EMAIL REDACTED] [EMAIL REDACTED] Call and confirm email submittals made it through City spam software. Questions: 527-3484 Rick Manchester 527-3485 Jo Selk 2. Required Attachments: Current year organizational budget summary. Most recent balance sheet and income statement. ---PAGE BREAK--- 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 16 or 17, 2014, time and day TBD. 4. If your organization is submitting a grant request to pay for field fees, please identify the amount of your grant request that will be used for City field fees. Actual field fees, more than the grant award, will be responsibility of the league organization to pay the City. There will be a voluntary grant writing workshop on March 26, 2014, 6:00-7:30 PM at the Rec Center if you need assistance completing your application. 5. Organizations that receive a grant will be asked to attend a voluntary non-profit board training and orientation in May. The training will be instructed by Tara Kuipers, from the University of Wyoming Cooperative Extension. You will be notified of the exact date, time, and location ASAP. This training may become mandatory of all grant recipients starting in 2015. ---PAGE BREAK--- Shoshone Recreation District Grant Application Form FY 2014/2015 (Please type or print legibly) Organization Requesting Funding Is your organization incorporated as a non-profit organization under WY State Law and IRS status? Yes No 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 an SRD application for funding? Yes No 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 2. What recreation services does your organization provide? Please explain. ---PAGE BREAK--- 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. Dollars requested: 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 $ General Liability Insurance? Yes No Insurance $ Field or facility fees? (explain) Field or facility fees $ Wages or Contract Labor (explain) (Not typically approved) Wages (Not allowed) $ Other (explain) Other $ ---PAGE BREAK--- Is it feasible to purchase equipment/materials in Park County School District Yes No 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. Yes No If yes, explain. If your organization received SRD grant funds in the past, how were the funds used and was it successful? Yes No If yes, explain. ---PAGE BREAK--- 6. Does your organization make scholarships available to participate in your program? Yes No If yes, explain. 7. Is your program open to participants with all skills and abilities? Yes No If no, explain. 8. Is there a selection or tryout process that limits the number of individuals involved that can participate? Yes No If yes, explain. 9. 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 2014 (This Year Projected) Residents Non-Residents 2013 (Last Year Actual) Residents Non-Residents 10. If your organization does not receive this grant will it be able to complete your project or program? (Please explain). ---PAGE BREAK--- Funding Sources ― Attach separate list if additional space is needed. Source (Name & location 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 Available Financial Resources of Organization Requesting Funding: Total Annual Operating Budget (Expenses) Total Financial Reserves Savings Account(s) $ Please explain $ Please explain 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 the governing board(s). Date: Authorized Representative’s (officer) Signature: Title: SIGN