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4 <br /> 10 <br /> 17. Has your organization or a related organization received funding from the Greater Triangle Community Foundation <br /> within the past three years? _ Yes X No If Iles, please list year, project and amount: <br /> IS. Mav 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 o: grantmakers. Your answer to this question will not affec: the <br /> Foundation's consideration of your proposal.) _yam Yes No <br /> 19. Checklist. Have you: <br /> y Described the community need or opportunity the proposed activity is intended to address? <br /> Explained the ways in which the project will address this need or opportunity in a creative or innovative way <br /> (for an existing project of excellence, described the impact of this program in the community, including <br /> X statistics or other relevant information)? <br /> X Thoroughly described the project or activity to be undertaken? <br /> X Determined the timetables for the project and for the requested funding? <br /> Stated your organization's capability to undertake the proposed project, including qualifications of personnel <br /> _x_ involved? <br /> Stated the specific objectives the program hopes to accomplish, in measurable terms if possible (for example, <br /> X number of people served)? <br /> Discussed the relationship of the proposed project to other programs in the community designed to meet the <br /> x same or similar needs or opportunities? <br /> _ Listed funds already committed for the project and the sources of these funds? <br /> y Indicated how future funding will be obtained, if the project is an ongoing one? <br /> Addressed the ways in which the project fosters or promotes ongoing cooperation, coordination of services, <br /> resource sharing, or mutual responsibility across county lines in the Triangle (For Regional Community <br /> _UL Grants only)? <br /> _ Enclosed 6 collated copies of. • this application form? <br /> * the narrative proposal, not to exceed three pages? <br /> _ • a detailed proposed project budget? <br /> current Board of Directors list, with affiliations? ` <br /> Enclosed 1 copy of: • your organization's overall operating budget? <br /> fig, • your organization's most recent IRS Form 990? <br /> NA • your IRS tax determination letter? <br /> 20. I 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 /> ` Signature of Chief Officer of the Board <br /> PLEASE REMEMBER TO COLLATE AND STAPLE PACKETS WITH APPLICATION FORMS ON TOP <br />