Seed Grant Application Community Heart & Soul Seed Grant Application 1Applicant Info2Community Info3Additional Materials Applicant City/TownPlease enter the following information for the City/Town applying for the Seed Grant.For application requirements please reference our Seed Grant Guidelines.Town/City* State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAmerican SamoaGuamNorthern Mariana IslandsPuerto RicoU.S. Virgin IslandsFederally Recognized TribeTribe Name* HiddenTown/City, State (Replaced)* Town/City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Population*Enter a number of the estimated population of your town/city.Please describe the geographic scope of your proposed Community Heart & Soul project.*Applicant OrganizationPlease provide information for the lead organization applying for the Seed Grant. Lead organizations may be local governments, 501(c)(3) non-profit organizations considered a public charity by the IRS, or informal resident-led groups.Organization Name* Contact Name*Please enter the name of the lead contact within the organization. First Last Mailing Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email* Enter Email Confirm Email Phone*Do you have a partnering organization?* Yes No Partnering OrganizationOrganization Contact NamePlease enter the name of the lead contact at the partner organization. First Last Mailing Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email PhoneIs there an additional partnering organization?* Yes No Additional Partnering OrganizationOrganization Contact NamePlease enter the name of the lead contact at the partner organization. First Last Mailing Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email PhoneDo you have a Fiscal Sponsor?* Yes No Fiscal SponsorPlease provide information for the fiscal sponsor if it is an organization other than the lead applicant. A fiscal sponsor must be designated in order to receive the grant funds.Organization Employer Identification Number (EIN) Contact Name First Last Mailing Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email Phone Community NarrativeTo prepare your narrative, refer to Getting Started With Community Heart & Soul: A Community Workbook, which is available for download. The workbook will help you and your partners prepare responses to the following questions. Describe your community*Tell us about your community's demographics, local assets, culture, etc. Who lives there? What brought them to your community and why do they stay? What contributes to your community’s unique history and culture?Do you intend to include more than one municipality in Community Heart & Soul?* Yes No Describe the municipalities involved*Tell us about the communities that will be involved, how the municipalities intend to collaborate, and the reasons you believe a multi-town effort makes sense for your community.Please Note: You must designate a lead applicant (and a fiscal sponsor to receive the funds) --however, all municipalities are expected to submit a letter of support. Explain why Community Heart & Soul a good fit for your community.*Why are you interested in implementing Community Heart & Soul? What do you hope the process will accomplish for your community?Tell us about the group of resident leaders involved in submitting this application and your plans to build a Heart & Soul team.*How will you establish a core leadership team for the Heart & Soul process? What preliminary ideas do you have to engage additional residents in the process?Describe the partner organizations supporting this project.*Who are your partners and what do they bring to the table? What, if any, experience do the partners have in collaborating on community issues or projects?What financial resources are available to support this project.*How will you match the $10,000 seed grant? How do you plan to cover costs such as the Project Coordinator, Heart & Soul Coach and other project expenses?Budget Note: Although we are not asking for a project-related budget, we encourage applicants to refer to Getting Started With Community Heart & Soul: A Community Workbook to familiarize themselves with the sample budget and costs associated with the Heart & Soul process. This question is meant to help potential grantees consider existing resources/assets in the community and how they might use these to support implementation of the model. Heart & Soul Coaches can provide additional guidance on budgeting to grantees as part of Phase 1.Is there anything else you'd like us to know about your application?*You may use this space to describe key factors or circumstances that could have an impact on Community Heart & Soul in your community. Additional MaterialsNote: please upload a doc, docx, or pdf of no more than 1MB.Letter of support from the governing body(ies)* Drop files here or Select files Accepted file types: doc, docx, pdf, Max. file size: 1 MB. Materials Note: Following grant approval, successful applicants must demonstrate municipal support for Community Heart & Soul with a Memorandum of Understanding and/or an adopted resolution by the governing body. Municipal support must be established before funds will be disbursed. Letter of support from fiscal sponsor Drop files here or Select files Accepted file types: doc, docx, pdf, Max. file size: 1 MB. Letter of intent for the matching fund commitment* Drop files here or Select files Accepted file types: doc, docx, pdf, Max. file size: 1 MB. Letters of support from partnersApplicants may submit additional letters of support from other partners to demonstrate commitment to the process. Drop files here or Select files Accepted file types: doc, docx, pdf, Max. file size: 1 MB. IRS Letter of DeterminationApplicants may submit additional letters of determination if they are a nonprofit applicant or fiscal sponsor. Drop files here or Select files Accepted file types: doc, docx, pdf, Max. file size: 1 MB. CommentsThis field is for validation purposes and should be left unchanged. Δ
