Test Form - The Diocese of Newark

Application: ACTS/VIM grant

"*" indicates required fields

Church Name & Town*

If "other" selected, enter name(s)*

If "other" selected, enter address*

Street Address City State / Province / Region ZIP / Postal Code

Check as many as apply

Congregation

501(c)(3)

Diocesan initiative

First time applicant

Project name

(if applicable)

Purpose of grant

(one sentence)

Project contact: Name*

First Last

Project contact: Email*

Project contact: Phone*

Clergy/Warden in Charge: Name*

First Last

Clergy/Warden in Charge: Email*

Clergy/Warden in Charge: Phone*

Grant request $*

Total congregation or institution budget (for current year) $*

Total project budget $*

Purpose of grant*

Please summarize in a short paragraph a summary of your grant request. Briefly explain why you are requesting this grant and how you will spend the funds if a grant is made.

Background of the Project

If the field does not apply to you enter not applicable

1). Please describe the needs of the community/congregation that you work to address, and the population that your organization serves.*

2). Current programs and accomplishments.*

3). Has your organization developed relationships with other organizations serving the same needs or population?*

Funding Request

Please describe the program or project for which you seek funding

4). How will this grant be used?*

5). Describe the goals and objectives of the project.*

6). Strategies that you will employ to implement the project.*

7). Proposed staffing for the project and their qualifications. (Number of paid full-time staff; number of paid part-time staff; number of volunteers.)*

8). Anticipated project length (if defined).*

9). What plans do you have for funding this project, both for this granting cycle and in the future?*

10). What percentage of the congregation is involved? In what capacities do church members serve?*

11). If this is a district application or multi-congregation application, list how each congregation will be involved with this project*