2007 GRANT APPLICATION (Applications must use this form and be completed electronically or typed)
Date: Applicant Organization Name (as shown shown on 501 (c) (3) letter): Mailing Address: City:
State:
Zip:
Executive Director(s): Director(s): Program Director: __ __
Phone:
Ext: Ext:
Program Director(s) email address: Program Title: Program Summary (25 words or less):
____________________________________________________________ _____________________________________________________________________________________ _________________________ When will the Program take place? Start:
End:
Please note funding will not be distributed until after October 1, 2007.
Amount requested from US Airways Education Education Foundation (not to exceed $5,000) $5,000) Total funding required for this Program: $ Program: $ Total annual organizational budget (not applicable for public schools): $ Percentage of total Program budget allocated to administrative costs: Do you receive funding from a federated campaign (i.e. United Way or United Campaigns)? Yes
% No No
If so, what percentage of your annual operating budget do you receive from a federated campaign: Does a portion of your fundraising for this program go to your national organization? Yes
%
No No
If so, how what percentage?
%
Geographic area to be served by this Program: Program: Description of population segment to be served: Estimated number to be served: Has your organization received funding from the US Airways Education Foundation (formerly the America West We st Airlin es Education Foundation) in the past? Yes
No No
If so, when? when?
________
Title of Program funded and amount: ____________________________________________________________________ _____________________________________________________________________________ _________
Please answer Please answer the fo llowing questions (in 500 500 words or less) and us e additional page pages s as necessary:
Describe your organization and the community it serves:
Describe the educational program to be funded with support from the US Airways Education Foundation, Inc.:
_______________________________________________________________ _______________________________ _______________________________________________ _______________ Specifically, how will money granted by the US Airways Education Foundation be used? State the specific goals you wish to achieve and describe the activities that will take place to reach those goals:
_______________________________________________________________ _______________________________ _______________________________________________ _______________ You will be required to provide a follow-up report. How will you evaluate and measure the impact of the grant and how will the grant provide visibility to US Airways?
Portion of budget to be supported by Education Foundation Grant
Personnel/Staff (include salary and benefits) a) Administrative
$
$
b) Teaching (including aides)
$
$
Total Personn el/S el/Staff taff Outside Fees and Services
$
$
a) Consultants
$
$
b) Other
$
$
Total Other Fees Fees and Se Servi rvi ces ces
$
$
Remaining Operating Expenses Expenses a) Supplies/Materials Supplies/Materials
$
$
b) Other (please list) list)
$
$
$
$
$
$
$
$
Total Re Remainin maining g Operating Expenses
$
$
TOTAL CASH EXPEN EXPENSES SES
$
$
ADDITIONAL ADDITIONA L PROGRA M FUNDING/SUPPORT List principal sources and amounts of on-going annual support already secured for this educational program:
a)
$
b)
$
c)
$
THE FOLLOWING INFORMATION MUST BE INCLUDED TO COMPLETE THE GRANT APPL ICATIONS. INCOMPLETE A PPLICA PPLICATIONS TIONS WILL NOT BE REVIEWED. 501 (c) (3) tax exempt letter Detailed operational budget outlining all sources of financial support Board of Directors list, including business affiliations and addresses _________________________ Executive Director’s Signature