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4 r <br /> 16. Has your organization or a related organization received funding from one of the Triangle Community Foundation's <br /> discretionary grant cycles within the past three years? Yes X No If Yes, please list cycle during which you <br /> applied (e.g., Fall 1995), project, and amount: <br /> 17. May the Foundation share your proposal with other potential funding sources? (The proposal will not be made <br /> available to the public, but only to potential donors or grantmakers. Your answer to this question will not affect the <br /> Foundation's consideration of your proposal.) X 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 address (providing <br /> 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 of <br /> excellence," described the impact of this program in the community, including statistics or other relevant <br /> information)? <br /> 3. Thoroughly described the project or activity to be undertaken and the amount of funding being requested <br /> from the Foundation? <br /> 4. Determined the timetable for the project? <br /> 5. Stated your organization's capacity to undertake the proposed project, including qualifications of personnel <br /> involved(i.e., why your organization is in a position to succeed with the project)? <br /> 6. Stated the specific objectives the program hopes to accomplish, in measurable terms if possible (for <br /> example, number of people served)? <br /> 7. Discussed the relationship of the proposed project to other programs in the community designed to meet <br /> 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 conies 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 1l cot)v of: <br /> - your organization's overall operating budget showing both income and expenses(one-page is fine)? <br /> - your organization's complete most recent IRS Form 990? (Please do not substitute your audit)* <br /> - your organization's IRS tax determination letter? * <br /> Not applicable to govemwnt agencies or r6li lolls con re adons <br /> 19. 1 hereby certify that the applicant organization does not discriminate on the basis of race,color, age, sex, religion, <br /> sexual orientation, physical disability, or national origin. <br /> Rod Vtsser, Assistant County Manager—for Shaping Orange County's Future Task Force <br /> PLEASE REMEMBER TO COLLATE Cm the order stated above) AND STAPLE PACKETS WTPH <br /> APPLICATION FORMS ON TOP. ANY ATTACFIlKE M OTHER THAN THOSE REOLIESTED ABOVE <br /> WILL BE DISCARDED. ALL APPLICANTS WILL BE NOTIFIED BY DECEMBER 1, 1-997- <br /> Triangle Community Foundation Page 3 of 3 Grant Application <br />