2024 COMMUNITY GRANTS

2024 COMMUNITY GRANTS

HOW TO APPLY Applicants complete Community Grant 2024 form and attach the following: 1. Recent completed, audited financial statement (if available) for most recent fiscal year. 2. Copy of the agency's most recent IRS Form 990. 3. Agency/program profit/loss and balance sheet for the most recent month, current year-to-date, and the prior year. 4. Current annual report or statement of program activities. 5. A one-page budget reflecting a realistic line item estimate of program costs. If cost exceeds grant request, manner in which additional funds will be raised. 6 Submit 14 printed copies of full request to Helen Werking, Executive Director, Riverside Hospital Foundation, 9090 Barrister Court, Jacksonville FL 32257.

Name of Organization*

Grantee #

Date of Request*

Amount of Request*

Cover Letter*

Total Amount of Budget*

Program/Project Title*

Project Description*

Project Start & End*

Geographical Area Served and Number of Individual*

Mission*

Goal*

OBJECTIVES & OUTPUTS Major Strategy*

ACTIVITIES The individual tasks/steps performe*

TIME FRAME Due dates for activities*

REQUIRED RESOURCES*

RESPONSIBLE PERSONS*

OUTCOMES Projected benefits/degree of change to*

Processes used to demonstrate outcome attainment*

How will project be funded in Future years?*

Other funding from Public and Private Sources*

Number of board members who made a financial cont*

Top 5 Staff Salaries*

List of Board of Directors*

Address*

City*

State*

Zip Code*

Phone*

Date of Incorporation*

Email Address*

Respondent's Name*

File Attachments*

Financial Statement, Form 990, Profit/Loss Statement, Annual Report, Budget

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