Grant Application
Milwaukee, Washington, Ozaukee or Waukesha Counties

Note: The applicant should print and complete this form by downloading a copy or simply providing the requested information in a typed format.

To download a copy, click here. (if prompted to enter a password, simply click "Cancel")

Organization Name_____________________________________________

Address_______________________________________________________

 
Street
City
State
Zip Code

 

Phone (______)___________________ Fax (______)___________________

Email_____________________ Website Address_____________________

Year of Incorporation__________ Year of Tax Exemption_________________

Staff Contact_______________________________________________

 
Name
Signature

 

                     ___________________________________________________

 
Title

Phone/Ext.

Board Officer___________________________________________________

 
Name
Signature

 

                     ___________________________________________________

 
Title
Phone

1. Choose the word or phrase which best describes your organization's mission.
Health/Human Services
Arts & Culture
Community/Economic Development
Education
Other: _____________________

2. List the number of individuals in each of the following employment categories for this fiscal year.
__________________Paid full-time staff
__________________Paid part-time staff
__________________Volunteers
__________________Interns
__________________Independent Contractors

3. Check organization's annual revenue category for the current fiscal year.
Under $100,000
$100,000-$249,999
$250,000-$499,999
$500,000-$999,999
$1,000,000-$1,999,999
$2,000,000-$2,999,999

4. Identify all appropriate populations that are served by your organization:
Children   Youth   Adults   Seniors   Families   Other:________________

5. Primary county served by your organization:
Milwaukee   Ozaukee   Washington    Waukesha   

6. Is your organization a member of any of the following (check any that apply):

United Way United Performing Arts Fund
Community Shares Community Health Charities

7. Does your organization meet the definition of "minority-led organization", based on the criteria in the Fund's policies?
Yes   No      

8. Funding request for:
MANAGEMENT ASSISTANCE ORGANIZATIONAL ALTERNATIVES
Corporate Structure/Board of Directors Merger
Program Restructuring
Human Resources Joint Project or Collaboration
Legal Dissolution
Facilities  
Finance  
Technology  
Fundraising  
Marketing  
Planning  
DIAGNOSTIC CLINIC    
Diagnostic Clinic  

9. List the name, address and phone number of the consultant, organization, or firm from whom you plan to receive the technical assistance outlined in this proposal.

Name______________________________________________________
Organization/Firm____________________________________________
Address____________________________________________________
Phone (______)__________________ Fax (______)__________________

10. How many bids did you solicit?_____________________________

11. Why did you choose this provider?____________________________
__________________________________________________________
__________________________________________________________

NONPROFIT MANAGEMENT FUND PROJECT BUDGET

12. List all expenses related to this grant request.

Consultant/Training $________________
Related expenses $________________
Hardware/software $________________
Materials $________________
Other:_______________ $________________
TOTAL: $________________

13. List all revenue sources for this project.

NONPROFIT MANAGEMENT FUND - requested amount $________________
Other foundation/corporate support $________________
Individual /Board contributions $________________
Cash from organization (Required 1:1 match for hardware/software) $________________
In-kind support from organization $________________
Other:_______________ $________________
TOTAL: $________________

14. Project time period: _____________________   _____________________

    (Beginning)
(Ending)       

 

In answering questions 15-17, please be specific and use no more than 2 single-spaced pages.

15. Describe the problem or situation that this grant will address.

 

 

16. Detail the type of management assistance that you are seeking. State the measurable objectives of your request. (What will be implemented?)

 

 

17. Determine the intended outcomes of the technical assistance. (What does your
organization expect to accomplish as a result of this grant?)

 

 

Please submit the following attachments with this application:

  • Complete list of your Board of Directors, including name, address, phone and affiliation
  • IRS tax-exemption letter
  • Budget for the current fiscal year
  • Audited financial statement for last fiscal year, or if unavailable, last year-end
    income and expense statement signed by your Treasurer
  • Brochure and annual report
  • Written agreement with technical assistance provider including a contract and
    consultant's workplan describing activities to be implemented and expected outcomes
  • Background information on the technical assistance provider

For Waukesha applications, mail or deliver to:
For Milwaukee, Washington and Ozaukee applications, mail or deliver to:

 

Nonprofit Management Fund
of Waukesha County
2212 S. Kinnickinnic Ave.
Milwaukee, WI 53207

   Nonprofit Management Fund
2212 S. Kinnickinnic Ave.
Milwaukee, WI 53207

   

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