2015-2016 Application for Community Assistance Funds

Name of Organization:

*Federal Tax Identification Number (EIN)

Organization Address, City, State, Zip:

*Organization phone:

Organization Website:

Contact person:

*Contact address, city, state, zip:

*Title:

*Contact phone:

*Contact email:

Contact fax:

*Requested Amount:

*Project Start Date:

Summary of Request (100 words or less - what specifically will the JL funds be used for?)

*When and how will success of this event be measured/evaluated (100 words or less)

What, if any, joint promotional opportunities are available?

Descriptions of your Organization

*Purpose, background (including date founded) and present activities.

*Present and past funding (last two years).

Sources of Funding for current fiscal year (List amounts for each and explain when necessary)

Grants

Corporate

Private

Earned

Other

Total

*Have you previously applied for Junior League support and/or funding?
yes no

If yes, please explain:

Date and place of incorporation.

Description of Specific Program for which Funding is being Requested

Project Proposal Description:

What East Baton Rouge issue(s) is your project addressing?

Why is this issue important to our community?

*Other funding sources for this program (source, date, amount):

*How will EBR residents benefit from your project?

What are the mission, vision and goals of your project?

*How will your project address the community issue?

Detail exactly what demographic and how many people will be impacted/served through this project.

*Are you requesting funding from other sources for this program?
Yes No

Please indicate your proposal’s area of impact (check all that apply):

health education cultural development

*Please explain how the CAF award will help you achieve the Junior League’s vision to "enhance the quality of life in the Baton Rouge community in the areas of physical health, education and cultural development”.

*Is this a new or extended service?
New Extended

*Other agencies providing similar services

* I certify that in submitting this form, I am acting as an agent for the 501(c)(3) organization named above.

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