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APPLICATION FOR TOWN OF MIDDLEBURG GRANT/CHARITABLE DONATION

  1. APPLICANT INFORMATION:

    Only non-profit organizations and public institutions of higher learning in Middleburg are eligible for a Town of Middleburg grant

  2. Please attach a copy of your IRS designation as a non-profit entity

  3. APPLICANT'S EXPERIENCE

  4. Please identify the applicant's experience in organizing events

  5. Please identify all partners assisting in the event, including their role.

  6. If the applicant has received past grants from the Town, identify the success of these grants. If no grants have been received, simply respond "N/A"

  7. Acknowledgement of Town Grant Policy*

    By checking this box, I agree I have read the Town Grant Policy and agree to abide by its terms and conditions. I understand that failure to follow the Policy can result in the denial of the grant application or the organization being required to return grant funds to the Town.

  8. EVENT FOR WHICH FUNDING IS REQUESTED

  9. Type of Event*

  10. Describe

  11. Describe IN DETAIL the event and how it will be executed, including the timeline for the event from planning to completion. If more space is needed, provide additional information through an attachment at the bottom of the application.

  12. GRANT FUNDING REQUEST

  13. Identify the purpose for which the funding is to be used, including the goal (i.e. if the purpose is marketing and the goal is to grow attendance, identify how the event will be marketed and the percentage of growth being targeted). If more space is needed to respond, please provide the additional information as an attachment at the bottom of the application.

  14. *Response to this item is mandatory if the funding request is for an item or service.

  15. MEASURES OF SUCCESS

  16. Describe the organization's plan for becoming self-sustaining within three-years of obtaining the first grant award from the Town or the goal for obtaining other sources of funding (beginning in 2020 if previously received grants). PLEASE BE SPECIFIC. If additional space is necessary to respond, please provide as an additional attachment at bottom of application.

  17. Describe IN DETAIL how the organization plans to promote awareness of the event.

  18. FINANCIAL RESOURCES/BUDGET

  19. Attach a line item budget for the entire event, including all projected revenues and all projected expenditures. If net revenue projected, identify use of those funds.

  20. Attach a copy of your organization's most recent audit or IRS 990 filing

  21. List any other sources of public funding being sought for the event, including the status of those applications.

  22. List any businesses, organizations or individuals who are providing financial support, including the amount of their contribution. If more space is needed to respond, include information as an attachment at the bottom of the application

  23. Identify any additional Town resources needed for the event (i.e. Police, trash collection services, etc.) If none, simply reply "N/A".

  24. Upload any additional items the organization wishes the Town to consider as a part of the grant application

  25. Electronic Signature Agreement*

    By checking the "I agree" box above, you agree and acknowledge that 1) the information provided in this application is true and correct to the best of your knowledge, and 2) if received, the Town grant funds will only be used for the purposes for which they are awarded. By checking the "I agree" box above, you further agree 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

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  27. This field is not part of the form submission.