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Mission: Wyoming Community Grant Program Wyoming Community Gas Guidelines WYMING C ll Ill Ill II II i { \ (1 I Cl 11 I ~ To wisely invest Wyoming Community Grants in programs that enhance quality of life with community projects in the Wyoming Choice Gas program service areas. Qualifying Projects o Arts and Culture o Community Improvement Qualifying Criteria o Grants cannot be used for operations, salaries or to supplement the general fund. o Grant monies must be used within one year. Progress reports are to be submitted to the Wyoming Community Gas office quarterly with completion documentation, including pictures, for a final project report. o Governmental entities and agencies (such as cities and towns) and organizations exempt from federal income tax under section 501(c)(3) or 501(c)(6) of the Internal Revenue Service Code may apply. o If a charitable organization, the organization must be in full compliance with all federal, state, and local laws or regulations. o Project must address community-related issues in communities in the Wyoming Choice Gas program area. o Grants generally will not be given to private foundations. o Grants will not be given to individual persons. o Grants will not be given to tax-supported organizations or religious groups and churches, except for programs or projects that broadly benefit the community. o Grants will not be given to individual pre-college schools or individual pre-college school foundations. Grant Requests Should Include The Following Information: o Completed Wyoming Community Grant Request Form o Completed Wyoming Community Grant Project Questionnaire o Total fund-raising goal for the project. o Organization's mission statement. o Organization's project budget and primary sources of funding. o List of the organization's directors and/or list of project committee members. o A copy of the organization's 501(c)(3) or 501(c)(6) tax-exempt status from the IRS. o A copy of the organization's W-9 form, which verifies its taxpayer identification number. o If a request is from a city or town, then a Resolution passed by the council must be attached. o Written permission from property owner if property to be used is not private (i.e. city, county, state, or federal). o If an entity is any form of a corporation, a certificate of corporate status must be provided. Grant requests must be mailed to Wyoming Community Gas (2348 SW Topeka Blvd., Suite 203, Topeka, KS 66611) postmarked no later than January 31, 2016. Grant requests will be reviewed by the Wyoming Community Grants committee who will make recommendations to the WCG Board of Directors. For I nformation contact: Natalie Flood, Wyoming Community Gas Business Development Manager, [PHONE REDACTED]. Mailing Address: 2348 SW Topeka Blvd., Suite 203, Topeka, KS 66611 ---PAGE BREAK--- Wyoming Community Grant Request Form Please return this form to: Wyoming Community Grant Program c/o Wyoming Community Gas 2348 SW Topeka Blvd., Suite 203 Topeka, KS 66611 PART A (to be completed by organization) WY6 MING C c1m111u11 i Iv G / Cl n I~ Date: _ _ _ _ _ _ Amount of Request: $ _ _ _ _ Organizat ion: _ Address: _ Contact Person: _ _ ~ Fed.ID#: _ Telephone: Fax : _ _ Email: _ • • • • Have you, or will you, receive funding from other organizations within the last year? Y or N If yes, total dollar amount received: $ _ • Will you be able to complete your objective if only partial ly funded? Y or N PART B Please attach copies of the following: ( ) Completed Wyoming Community Grant Project Questionnaire ( ) IRS SOl or SOl status letter and W-9 form ( ) Supporting documents ( ) Project Budget ( ) Others who financially support the organization & their contribution levels ( ) List of organization's directors and/or project committee members ( ) Corporate Status Certificate I certify that this project meets all criteria as outlined in the guidelines and have provided all documents required in Part B. x Print ---PAGE BREAK--- WYb MING c• mm 1111 ; I \ G 1 11 111 ' Wyoming Community Grant Project Questionnaire Please answer the following questions omitting any proper names of people, towns or other identifying landmarks to avoid any unfair bias in the grant selection process. 1. Brief description of the program or project for which funding is being requested: 2. Target population: 3. Number of people served: 4. Amount of Request: $ _ 5. Have you, or will you, receive funding from other organizations within the last year? a. Yes or No. If yes, total dollar amount received: $ _ 6. Will you be able to complete your objective if only partially funded? Yes or No 7. Desired impact: _ 8. How Wyoming Community Gas and the Wyoming Community Grant Program will be promoted as the grantee: _