Allegany Franciscan Ministries

ACOR Online Grant Application

Please fill out the application completely. Read all of the questions before you begin. You will not be able to save your work and return later. If you have any questions, call Erin Baird at (727) 507-9668 ext. 207.

COVER PAGE
Please provide the following contact information for your organization.

Organization name
Federal Tax ID Number
Mailing address
City
State
Zip code
Country
Telephone number
Fax number
Web site
Executive Director/CEO name
Executive Director/CEO title
Fiscal Agent name & address (if applicable)
Fiscal Agent contact person name & title (if applicable)

To whom should Allegany Franciscan Ministries respond? Please provide your contact information below.

Name
Title
E-Mail address
Telephone number

Is your mailing address the same as the organization's address?	Yes No

Mailing address (if different than organization)
City
State
Zip code
Country

GRANT APPLICATION QUESTIONS
Please answer the following questions keeping in mind the word limits.

Program title
Provide a brief history and purpose of the organization. (If your organization is affiliated with Catholic Health East, describe your affiliation here).-200 word limit


Geographic area served (i.e. county, city, neighborhood) - 100 word limit


Population served (i.e. children, elderly, homeless) - 100 word limit


Describe the need for your program. How did you determine this need? - 200 word limit


Describe the program for which you are seeking funds. Please include information such as what you will do, who you will serve, what you hope to accomplish, and your organiztion's experience working with the target population. - 300 word limit


Identify how your program meets the ACOR Priority Criteria listed on page four of the ACOR Grant Application Kit. - 200 word limit


BUDGET INFORMATION
Please provide answers to these budget questions regarding your organization and proposed program.

Total organization budget
Total program budget
Total requested from Allegany Franciscan Ministries (not more than $5,000)

Funding sources obtained for this program.

Funding sources requested for program: status pending or denied

Have you applied to St. Elizabeth Mission Society for funding this program? (CHE-affiliated applicants excluded)	Yes No



Complete the table below estimating the general line items in the budget. Briefly describe the specific expenses within each line item.

Budget Category	Total Program Budget	Funding Requested from AFM	Description of Expenses
Personnel	$	$
Supplies	$	$
Equipment	$	$
Food	$	$
Travel	$	$
Construction/repairs	$	$
Scholarships	$	$
Other	$	$
Total	$	$


Remember to submit your Affiliation Form and your IRS 501 (c)(3) determination letter by either scanning the documents and then emailing them to grants@afmfl.org or by faxing them to 727-507-8557. Click the button below to submit your ACOR grant application.

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