You are on page 1of 2

MINISTRY CHARITY PROJECT

GRANT APPLICATION

This form is to be completed before WaterStone makes any grant to a foreign or domestic organization that is not a controlled or closely affiliated organization, and does not have a United States based affiliated 501(c)(3) organization. The purpose is to establish the fact that prior to the grant, this organization conducted an inquiry concerning the potential grantee complete enough to give a reasonable man assurance that the grantee will use the grant to accomplish this organization’s exempt purposes. MCP GRANTOR

Ananda Foundation
GRANT AMOUNT REQUESTED

MCP #

10743

DATE

January 20, 2012

$USD 4,421

Part I GRANTEE INFORMATION (Please print)

Positive awareness service society (PASS) ADDRESS 42, Vallalar street,Ramakrishnapet US Federal Tax ID# N/A Tamil Nadu, India CITY ARNI STATE ZIP 632301 PHONE +91 4173 222188 E MAIL ADDRESS suresh_g2003@rediffmail.com DATE FOUNDED 1995
ORGANIZATION NAME PLEASE NOTE: INCOMPLETE APPLICATIONS MAY NOT BE CONSIDERED Part II Purpose Statement of the Organization and Incorporation documents or NGO certificates (Attach Schedule A)

Part III List of Board of Directors, Officers, Key Personnel (Attach Schedule B) Part IV List the Purpose and Budget for Grant Application (Attach Schedule C) Part V Summary Statement of Knowledge about this Organization (Attach Schedule D: to include, brief history, previous known grants or financial assistance received, experience of the chief personnel, organization’s overall activities and practices.) STATEMENT OF UNDERSTANDING: By signature below, the following terms, conditions and understandings are agreed upon by the parties. Grant award is contingent upon the availability of funds and approval from the Board of Directors. Any portion of the fund not used within the grant period and/or for the stated purpose stated, must be immediately returned to WaterStone. GRANTEE shall provide WaterStone with immediate notification of any significant changes in your organization’s structure, or operation, if you are unable to expend the grant for the purpose described or if any expenditure from this grant has been made for any purpose other than those for which the grant was intended. GRANTEE shall submit a full and complete report due to include a general ledger with accounting of how the grant funds were spent and an evaluation of the effectiveness of the purpose with pictorial verification. This report shall supply sufficient information as necessary for WaterStone to determine that the funds were used for the intended purposes. Reports are due within 30 days of expiration date and must include both program services and financial reports. For GRANTEE to be re-considered for another grant, all reports must be complete and received on time.
Revised 09/13/2010 G:\Forms/Funds Page 1 of 2

The Foundation for Living. Defined.

GRANTEE shall indicate the grant funds separately on your books of account, maintain an accurate record of the funds received and expenses incurred under this grant in accordance with generally accepted accounting principles, and retain such books and records for at least four years after the completion of the use of this grant award. GRANTEE shall permit WaterStone at its request, to have reasonable access to your files, records and personnel for the purpose of making such financial audits, verifications or program evaluations as it deems necessary concerning this grant award. No part of the grant funds is to be used to carry on propaganda, or otherwise attempt to influence legislation, or to influence the outcome of any specific public election. Any violation of the conditions set forth above will require a refunding to WaterStone of any amounts subject to the violation. WaterStone reserves the right to discontinue, modify or withhold any payments due under this grant award or to require a refund of any unexpended grant funds if, in its judgment, such action is necessary to comply with the requirements of any law or regulation affecting its responsibilities under this grant award. GRANTEE shall remain solely responsible and liable for its respective claims, debts, obligations, and liabilities. GRANTEE hereby agrees to indemnify and hold harmless the GRANTOR with respect to any loss, claim, liability, or costs defending the same (including reasonable attorney fees and expenses) arising because of the action or inaction of the GRANTOR. In the unlikely event a claim or controversy should arise out of this Agreement, or any of its provisions, the parties hereto agree to seek resolution by Biblical means of conciliation and further agree to submit such dispute, claim or controversy to Peacemaker Ministries, Inc. or other such Christian conciliation services. If approved, checks will be issued and payable to the grantee domestic organization, unless wiring instructions are given below. All foreign grants will be wired. Please provide correct typed or printed wiring instructions.

Positive Awareness Service Society BANK NAME Indian Bank , Bank Branch: ACCOUNT NUMBER 580377699 SWIFT CODE DIBINBBMAS ABA# OR CORRESPONDING USA BANK Bank Branch: Vadamathimangalam
ACCOUNT NAME The above conditions are understood and accepted. Signatures obtained may be faxed or electronic and may serve as originals. GRANTEE:

Signature, Title,

Print Name

Date

1 year Grant Amount $4,421
Grant Term

February 2012 Expires January 2013 Funding Frequency: 1 number of payments (maximum 4 payments)
To Commence

I accept the grant terms and conditions and agree to monitor GRANTEE progress and I will assure grant reports are received on time: PROJECT MANAGER:

Levani R. Lipton
Signature Print Name Board of Directors acceptance of Grant Application and Conditions: GRANTOR: WaterStone Support Foundation, Inc.

1/20/2012

Date

Valerie Cornelius, Treasurer Signatures obtained may be faxed or electronic and may serve as originals.
Revised 09/13/2010 G:\Forms/Funds Page 2 of 2

Date

The Foundation for Living. Defined.