Lost Tree Charitable Foundation: Initial Proposal Form

Deadlines and Procedures
Initial Proposal Summary
Conditions of Grant Awards

* Use the TAB button to navigate through the form. submit when complete.
* All fields must be completed. Incomplete requests may not be considered.
* Use $ signs and decimals where applicable.

Date:

Name of Agency:
Federal ID #:
501(c)(3): Yes No

Year Founded:

Address:
City/State:
Own Rent

Executive Director
Telephone:

Contact Person for this Proposal:
Title:
Email Address:
Telephone:
Fax:

Agency Website:

Agency Operating Budget:
Date on which fiscal year ends:

Do you have audited financial statements? Yes No

If No, explain why:

Number of Clients Served:

Total number of employees:

Full-Time:
Part-Time:
Total number of volunteers:

Annual Salaries of Top Three Staff Members:

Title:
$:
Length of Service:

Title:
$:
Length of Service:

Title:
$:
Length of Service:

Mission of Organization:

List principle sources or support for your agency such as
United Way, Children's Services Council, government grants,
local foundations, special events, individual contributions:

Total Amount Requested:
Total Project Budget:

Title, Purpose and Description of Project:

Include need for the project or item(s) requested. State specifically
what the requested funds will be used for. Define the objectives of
the project and anticipated outcome. Include the geographic area
and number of people to be served.

List Sources of support for this project:

Applied for:
Name: $:
Name: $:
Name: $:

Committed:
Name: $:
Name: $:
Name: $:

Received:
Name: $:
Name: $:
Name: $:

Anticipated Project Start Date:

We recommend printing completed proposal for your records/files.