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ECWANDC Application Summary Sheet June 2008

ECWANDC Application Summary Sheet June 2008

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Funding form 2 of 3

Please read through the application before filling it out to ensure you have everything required to process your application. The length of the form is based on City requirements. Although a precise application should streamline the process, please allow enough time prior to your event to finalize purchases/funding.

NOTE: you may turn in the application without proper back-up (501 c3 paperwork, et al), YOU CANNOT BE FUNDED UNTIL EVERYTHING HAS BEEN TURNED INTO THE CITY FOR FINAL APPROVAL!!!

Funding form 2 of 3

Please read through the application before filling it out to ensure you have everything required to process your application. The length of the form is based on City requirements. Although a precise application should streamline the process, please allow enough time prior to your event to finalize purchases/funding.

NOTE: you may turn in the application without proper back-up (501 c3 paperwork, et al), YOU CANNOT BE FUNDED UNTIL EVERYTHING HAS BEEN TURNED INTO THE CITY FOR FINAL APPROVAL!!!

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09/16/2014

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EMPOWERMENT CONGRESS WEST AREA NEIGHBORHOOD DEVELOPMENT COUNCIL
APPLICATION SUMMARY SHEET
PROJECT TITLE:PROJECT TYPE: Community Improvement Community-Wide Special EventBRIEF PROJECT DESCRIPTION
(50 WORDS OR LESS):
 
PROJECT SITE NAME:ADDRESS OR LOCATION DESCRIPTION
:
Community Impact Statement
:
please describe (a) the intended participants and beneficiaries including the projectednumber of participants; and (b) how the public or NDC will benefit from the project
DATE SUBMITTED: START DATE: COMPLETION/EVENT DATE:LEAD ORGANIZATION NAME: 501( C )3 ?
Yes No
HEAD OF ORGANIZATION:
 
MS.MR.
TITLE:MAILING ADDRESS:
 
DAY PHONE:
 
EVENING PHONE:
 
CELL PHONE:
 
E-MAIL ADDRESS:
 
FAX:PROJECT MANAGER
(must be different than head of org): 
MS.MR.
TITLE/ROLE:
 
MAILING ADDRESS:
 
DAY PHONE:
 
EVENING PHONE:
 
CELL PHONE:
 
E-MAIL ADDRESS: FAX:
If not a non-profit – please list at least five ECWANDC Stakeholders participating in/supporting the proposed project 
.
Print NameStreet Address + ZipPhone #:EmailSignature
 
Effective 4/8/09
 
ECWANDC APPLICATION FOR FUNDING – continued
 
FUNDING REQUEST:
$
MATCH CONTRIBUTION
$
TOTAL PROJECT BUDGET
$
Has the applicant organization received ECWANDC funding? No YesIf yes - Month/Year: Funding Received For:Has the applicant organization received funding from another NC? No YesIf yes - Name of NC: Funding Received For:
NARRATIVE
On a maximum of four (4) pages, please provide the following information:
[1]
Description of Organization
: please provide: (a) a brief description of the mission or history of the group; (b)its relationship or role in the ECWANDC area.[2]
Community Partnerships
: please provide the names including the contact information of the individuals and/ororganizational partners both inside and outside ECWANC area and a brief description of their role in and financialcontribution to the project. Provide letters of support and/or collaboration with other community groups etc., if applicable in the attachment section.[3]
Project Description
: please provide: (a) description of the project; (b) a brief history or justification for theproject. (c) the goal(s) and objectives for the project; (d) the plan for outreach and informing the community; and(e) how the contribution of the ECWANDC will be acknowledged.[4]
Scope of Work
: please provide a list of the major steps to be taken and corresponding timeline that clearlyshows when each phase of the project will be completed.[5]
Budget
: Please provide a detailed budget delineating the following information: (a) the total budget includingall anticipated income and expenses including materials and resources needed to accomplish the project; (b) theportion or dollar amount for items or services requested from the NDC; and (c) a list of the source and dollaramount of the matching funds, value of volunteer hours or other non-cash contributions to satisfy the matchrequirement. Include written proposals from sub-contractors, vendors, documentation of matching funds, etc., inthe attachment section. Multiple estimates are not required, but are encouraged. Purchases and subcontract withvendors within the ECWANDC area are also encouraged.[6]
Budget Justification
: provide a brief explanation of each item listed including unit cost, number of units.
OTHER TERMS/REQUIREMENTS
 As a condition of funding, all projects approved for funding are required to:
Submit a brief (no more than 1 page) report and evaluation to the NC within 45 days of the completion of theevent describing: outcome of the project; completion date; number of persons that participated in the event, list of partners and/or contributors, volunteer hours completed and pictures of the completed project or event. Alsoattaché a copy of the program, press release or any outreach or promotional materials
 A final accounting to the Treasurer, clearly showing all of the income and expenses, including sources of incomeand details of expenses
BY SIGNING BELOW
, I agree to the terms of the ECWANDC and City of Los Angeles DONE guidelines and procedures. I also acknowledgethat the information submitted in this application is accurate to the best of my knowledge. Submitting an application with misleadinginformation may be cause for disqualification
.
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