Pickaway County Community Foundation

Smart Growth Initiative

Application for Grant Funding

Fill this form in below, then print it or save it as a PDF.

Pickaway County is amid an historic period of growth and change. As part of one of the fastest growing metropolitan areas in the country, our community leaders are faced with new opportunities and challenges almost daily. The Smart Growth Initiative will provide the opportunity for the sharing of ideas and best practices, the crafting of shared vision and the development of tools and resources to help realize our community’s greatest potential.

Resources secured through this fund may include, but are not limited to, educational forums, land use plans, zoning code updates, infrastructure planning, grant writing, and development of other tools and resources consistent with this purpose.

Return the completed application and documents to tanderson@pickawayprogress.com. Direct questions to 740-420-6498.

Attach the following to the application

A summary of the proposed project
Project budget showing all sources of income/expenses (including other grants received)
Organization’s budget
List of all board members for the organization
Evidence of organization’s good financial standing: if 501(c)(3), most recent Form 990; for local government, most recent state audit
IRS designation letter (501(c)(3) only)
Resolution from council/board approving application

Organization

Organization name Date Organization contact Title Street City State Zip code Phone Email Mission statement of organization

Project Funding

Total cost of project ($) Amount requested ($) Estimated time period / duration of project

Tax Exempt Status

501(c)(3)

Yes No

If yes, federal tax ID #

Please attach the IRS designation letter (501(c)(3) only).

If not 501(c)(3)

Municipality Local government

State verification #

All applicants please attach a resolution from council/board approving your application.

Project Narrative

Description of the purpose & need of the project (educational, planning, zoning, infrastructure, other — provide information on the project you intend to address with this program and why it’s needed) How will this project benefit Pickaway County / area of our community? Describe the resources your organization will dedicate to this project (in addition to your organization’s funds, what other funding streams will be used) What are the expected results from this project & how will you measure its success? (include key performance indicators and specific numbers)

Certification

I certify the information provided in this application is true to the best of my knowledge.

Printed name of organization contact Printed name of project chairperson Signature of organization contact Signature of project chairperson Date Date