| All fields are required. |
| Organization Information: |
| What is the name of your organization?: |
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| Address: |
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| Email address: |
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| Phone Number: |
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| Federal Tax ID#: |
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| Grant Request: |
| What is the grant amount you are requesting?: |
$ |
How will this grant be used?
This description should be at least one or two paragraphs. Be sure to provide a specific budget breakdown of how the funds will be spent. Also provide the number of individuals that will be affected through this grant.
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| Will this grant help to provide a new service or enhance a current program? |
YesNo |
If yes, please explain.
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| Organization History: |
Briefly describe the history of your organization.
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| Services: |
Briefly describe the organization's services as well as those who benefit from the services.
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| How many clients/individuals does your organization serve annually? |
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| In which counties does your organization provide services? |
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| How many GE Consumer & Industrial families has your organization benefitted? |
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| Staff and Volunteers: |
| How many paid, full-time staff members are employed by your organization? |
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| What is the total salary for all paid, full-time staff members? |
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Briefly describe the employees' responsibilities.
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| How many volunteers does your organization have? |
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Briefly describe the volunteers' accomplishments.
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| Funding: |
Where does the majority of your support come from?
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| Are you a United Way agency? |
YesNo |
| If yes, do you have approval from the United Way to request grants from the ECF? |
YesNo
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| If no, have you applied to the United Way for funding? |
YesNo
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Please explain.
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| Have you applied to any other organizations for funding for this request? |
YesNo |
| GE Funding and Donations: |
| Has your organization received grants from the GE ECF in the past? |
YesNo |
| If yes, please give the amounts and dates. |
| Amount: |
$ |
| Date: |
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| Amount: |
$ |
| Date: |
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| Amount: |
$ |
| Date: |
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How was the most recent ECF grant used?
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| In the past five years, has your organization received any other GE corporate contributions (such as appliances, matching funds, "More Gifts... More Givers," etc.)? |
YesNo |
| If yes, please give the amounts and dates. |
| Amount: |
$ |
| Date: |
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| Amount: |
$ |
| Date: |
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| Amount: |
$ |
| Date: |
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| Have there been any other contributions made by GE employees to your organization? |
YesNo |
If yes, please explain.
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| This application was prepared by: |
| Name: |
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| Title: |
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| Date: |
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| Who is your ECF contact person at GE? |
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