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16.Has your organization or a related organization received funding from one of the Triangle <br /> Community Foundation's discretionary grant cycles within the past three years? _ yes x No <br /> If Yes, please list cycle during which you applied (e.g., Fall 1995), project, and amount: <br /> 17.May the Foundation share your proposal with other potential funding sources? (The proposal <br /> will not be made available to the public, but only to potential donors or grantmakers. Your <br /> answer to this question will not affect the Foundation's consideration of your proposal.) <br /> Yes NO <br /> 18. Checklist (Refer to the Information on Grants section for more detail). Have you: <br /> 1. Described the community need or opportunity the proposed "activity is intended to <br /> address( providing evidence, if possible, in measurable terms)? <br /> 2. Explained the ways in which the project will address this need or opportunity (for an existing "project <br /> of excellence," described the impact of this program in the community, including <br /> statistics or other relevant information)? <br /> 3. Thoroughly described the project or activity to be undertaken and the amount of funding <br /> being requested from the Foundation? <br /> 4. Determined the timetable for the project? <br /> 5. Stated your organization's capacity to undertake the proposed project, including <br /> qualifications of personnel involved (i.e., why your organization is in a position to <br /> succeed with the project)? <br /> 6. Stated the specific objectives the program hopes to accomplish, in measurable terms if <br /> possible (for example, number of people served)? <br /> 7. Discussed the relationship of the proposed project to other programs in the community <br /> designed to meet the same or similar needs or opportunities? <br /> 8. Listed funds already committed for the project and the sources of these funds? <br /> 9. Indicated how future funding will be obtained, if the project is an ongoing one? <br /> 10. Explained how you intend to evaluate progress toward your stated goals and objectives? <br /> 11. Enclosed 6 collated copies of: <br /> - this application form? <br /> - the narrative proposal, not to exceed three pages of 12-point or greater font size? <br /> a one-page proposed project budget with explanations for each item? <br /> current Board of Directors list, with organizational affiliations and/or occupation? <br /> 12.Enclosed 1 cony of: <br /> - your organization's overall operating budget showing both income and expenses <br /> (one-page is fine)? <br /> - your organization's complete most recent IRS Form 990? (Please do not substitute <br /> your audit)* <br /> - your organization's IRS tax determination letter? <br /> Not applicable to government agencies or relgious congregations) <br /> 19,1 hereby certify that the applicant organization does not discriminate on the basis of race, color, <br /> age, sex, religion, sexual orientation, physical disability, or national origin. <br /> um, . l <br /> Signature of Chief Officer of the Board <br /> PLEASE REMEMBER TO COLLATE (in the order stated above) AND STAPLE PACKETS WITH <br /> APPLICATION FORMS ON TOP. ANY ATTACHMENTS OTHER THAN THOSE REQUESTED <br /> ABOVE WILL BE DISCARDED. ALL APPLICANTS WILL BE NOTIFIED BY JUNE 15, 1997. <br /> Trianifle Conununitv Foundation Page 3 of 3 Grant Application <br />