Form Center

Step One

Before You Start ...
To complete this application, you will need full contact information for your organization, including Federal Employer ID number; your organization's mission statement and detailed information on the organization's structure and operations; documents including a list of current board members, a statement of financial position, and a budget-to-actuals report.
Be sure to save your progress often using the button in the upper right corner. If you created an account for the old Smartsheet form, you'll need to create a new one for this website.
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Mission & History*
Provide your organization's mission statement and founding date.
Populations Served*
Describe your target clientele (e.g., age, income, special needs, family structure, qualifications, etc.)
Programs & Services*
Describe your organization's programming and your goal in providing it.
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What progress did you make on your priorities in Lincoln County during the past year?*
Examples: Number of people served, projects completed, objectives met, etc.
Describe any specific challenges or barriers your agency faces in serving its clients or delivery of programs*
How does your agency anticipate using the requested funds in Lincoln County during the next year?*
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Please list the number of:
(Use a zero if none)
Board Members*
Staff*
Full-time equivalent (FTE) staff*
FTE staff who are executive staff (e.g., director)*
Volunteers*
When does your fiscal year begin and end?*
1. January-December
2. July-June
Organizational Financial Summary:
Budget for current fiscal year
Actuals-to-Date for Current Fiscal Year
Actuals for Last Completed Fiscal Year
Revenues*
Revenues*
Revenues*
Expenses*
Expenses*
Expenses*
Surplus/Deficit*
Surplus/Deficit*
Surplus/Deficit*
Describe any significant difference, operating increases or deficits between prior and current budgets*
(e.g., increase or reduction in staff, facility purchase or sale, program start or end)
What new financial support have you solicited during the past 12 months and what were the results?
Please limit to amounts greater than $2,500. If none, leave blank.
Source
Agency or organization funds were solicited from
Amount Requested
Result
Source
Agency or organization funds were solicited from
Amount Requested
Result
Source
Agency or organization funds were solicited from
Amount Requested
Result
If your organization solicited financial support from more than three sources last year, list them here
List organization or agency name, amount requested and result separated by commas
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What is your procedure for making client referrals for services you are unable to provide?*
Briefly describe any current collaborations you are engaged in to deliver services and strengthen your impact*
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Describe specifically how your programs/facilities are accessible under Americans with Disabilities Act requirements*
If not accessible, provide a plan for making programs accessible
Describe specifically how your organization is acting on its commitment to diversity, equity and inclusion*
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List of Current Board Members*
Most Recent Statement of Financial Position*
Also known as a balance sheet
Budget to Actuals*
Also known as a statement of activities, income and expense, or profit and loss statement
Optional document
Document that provides additional or clarifying information
Electronic Signature Agreement*
I hereby affirm that all the stated information provided by me to the Lincoln County Grant Review Committee is true, correct and without forgery. By Clicking "Agree," I consent to submitting my signature in electronic form as well as to having my picture taken and used for any purpose deemed necessary to promote the grant program.
1. I agree.
Electronic Signature
All submissions are final and cannot be revised once submitted

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