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Grant Application

Please note: If you received a grant check in January of 2019, please make sure a grant report or extension request was submitted on or before June 15th, 2019.

Be sure to check out the Grant Guidelines

Name of Organization  
Date Prepared  
eMail Address  
When Organized  
Date and Place of Incorporation  
Incorporated as Non-Profit?   Yes     No
Has your organization qualified as a non-profit, tax deductible entity under the US internal revenue code 501(c)(3)?   Yes     No
If NOT, enter application date  
Employer Identification Number (E.I.N)  
Total Amount Requested  
Is this amount for one Fiscal Year?   Yes     No
If NO, for what period?  
Use of funds: Please outline proposed project or program. Identifying both your target population and your planned method of improving that group's quality of life. Be specific. Please attach a detailed budget for the use of the requested funds.
(1000 characters max - includes spaces)
State your organization's objectives
(400 characters max - includes spaces)
Briefly summarize your organization's current efforts towards achieving those objectives.
(400 characters max - includes spaces)
What geographic area do you serve?
(150 characters max - includes spaces)
Describe your agency's efforts to collaborate with other organizations whose services parallel, duplicate, or aid your work.
(400 characters max - includes spaces)
Name and title of paid staff head  
Date of appointment  
Prior affiliation  
FINANCES: Please complete with respect to applicant organization only. Do Not include parent company financial information.
Organization's Fiscal Year From Month Year
  To Month Year
Revenue received last fiscal year excluding capital campaign funds  
Total government revenue received last fiscal year  
Total expenditures last fiscal year  
Total approved budget for current fiscal year  
Salary range, including deferred compensation, for all of your organization's paid employees   From $ To $
List the methods of fund raising, used or planned (direct mail, membership solicitation, corporation/foundation solicitation, etc.), that generate your organization's revenue.
(350 characters max - includes spaces)
List any outside fund raisers and your payment rate to them.
(250 characters max - includes spaces)
Accounts are audited by:   Certified Public Accountant
An Auditing Committee
Frequency of audits  
Please include the following with your application:   1. Copy of US Treasury ruling granting your organization status as a non-profit, tax deductible organization under section 501(c)(3)
Sent by  
Received by AFCC   to be completed by AFCC
    2. Complete audit for the previous fiscal year
Sent by  
Received by AFCC   to be completed by AFCC
    3. If combined cost of administration, public relations, and fund raising exceeds 20% of total expenditures for the previous fiscal year, please enclose a statement explaining your high administrative expenses
Yes, it does exceed 20% (I have included an explanation)  
No, it does not exceed 20%  
    4. List of corporate donors ($200 or more)
Sent by  
Received by AFCC   to be completed by AFCC
    5. Project or program budget
Sent by  
Received by AFCC   to be completed by AFCC
I certify that the aforementioned and enclosed information is complete and accurate.    
Name (person to contact if we have questions)  
Home Telephone number
(Mandatory - this number will be kept private and only be used in case of an emergency)
Work Telephone number  
Our application may not be submitted electronically. After you have completed the application, please click the grey bar, print it out, sign it, enclose additional information (1-5), and mail to:
Andrade-Faxon Charities for Children, PO Box 3305, South Attleboro, MA 02703