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Name of Organization:
________________________________________
Address: ________________________________________
Phone #: _______________________________
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Executive Director:
_______________________________ |
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Contact Person:
_______________________________ |
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email: _________________________ |
and/or
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phone: _____________________ |
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Provide a description of your
organization, who you are and what you do. (Not to exceed
one page)
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List grants received from our
foundation over the past 5 years, including amount and purpose:
________________ ________________________________________
________________ ________________________________________
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Amount requested with this proposal:
________________
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Purpose of the request: What are you
hoping to accomplish? (Not to exceed two pages)
Fiscal and Budget Information:
Submit an organization budget and a project budget (assuming it is a
project for which you are applying) for the year to which this request
pertains. Itemize by source and funder on both the organization budget and the project budget
all funding committed (c) or pending (p) from each foundation,
corporation/business, and government entity. If this request is for a
start-up project, submit a first year start-up budget and a first full
year projected budget.
Please note any significant change in
funding your organization has experienced or is anticipating, (increase
or decrease), and let us know the reason for the change.
Required Attachments:
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Documentation of tax exempt status
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Current Roster of the Board of
Directors
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For a renewal grant, submit a year-end
one-page report on the previous grant received and the year received.
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A copy of the last annual report, if
available
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An organization chart, if applicable
Allowed attachments, but not required:
Reports, copies of articles, or newsletters that describe your
organization, or touts your work.
Miscellaneous:
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Do not include a cover letter.
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Proposal should be printed in readable
size font (at least 12pt).
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No 2-sided printed/copied pages
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No delivery that requires a signature
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No video, audiotapes, CD’s unless
requested
Mail to:
Toni Rembe, President
van Loben Sels/RembeRock Foundation
131 Steuart St., Suite 301
San Francisco, CA 94105
If you have any questions or need
clarification on any of the items listed above, please call Dan
Corsello, E.D., at (415) 512-0572, or Gail Shuster, Program
Administrator, at (415) 512-0500.
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