BILLY ANDRADE - BRAD FAXON CHARITIES FOR CHILDREN PO BOX 3305, SOUTH ATTLEBORO, MA 02703 (508) 761-3525 A 501(C) 3 Charitable Organization Serving RI & S.E. MA Children’s Charities
	GRANT APPLICATION     Name of Organization Date Prepared Email Address PRINCIPAL OFFICE   Address City State Zip Telephone When Organized Date and Place of Incorporation Incorporated as Non-Profit? Yes No Has your organization qualified as a non-profit, tax deductible entity under the US internal revenue code 501(c)(3)? Yes No If NOT, enter application date REQUEST   Total Amount Requested Is this amount for one Fiscal Year Yes No If NO, for what period? Use of funds: Please outline proposed project or program, identifying both your target population and your planned method of improving that group's quality of life. Be specific. Please attach a detailed budget for the use of the requested funds. (1000 characters max) PURPOSE AND PROGRAM State your organization's objectives (400 characters max) Briefly summarize your organization's current efforts toward achieving those objectives. (400 characters max) What geographic area do you serve? (150 characters max) Describe your agency's efforts to collaborate with other organizations whose services parallel, duplicate, or aid your work. (400 characters max) Name and title of paid staff head Date of appointment Prior affiliation FINANCES: Please complete with respect to applicant organization only. Do Not include parent company financial information. Organization's Fiscal Year From Month   Year     To Month   Year   Revenue received last fiscal year excluding capital campaign funds Total government revenue received last fiscal year Total expenditures last fiscal year Total approved budget for current fiscal year Salary range, including deferred compensation, for all of your organization's paid employees From $   To $   List the methods of fund raising, used or planned (direct mail, membership solicitation, corporation/foundation solicitation, etc.), that generate your organization's revenue. (350 characters max) List any outside fund raisers and your payment rate to them. (250 characters max) Accounts are audited by: Certified Public Accountant An Auditing Committee Other (specify) Frequency of audits     ADDITIONAL INFORMATION   Please include the following with your application: 1. Copy of US Treasury ruling granting your organization status as a non-profit, tax deductible organization under section 501(c)(3) Sent by Received by AFCC to be completed by AFCC   2. Complete audit for the previous fiscal year Sent by Received by AFCC to be completed by AFCC   3. If combined cost of administration, public relations, and fund raising exceeds 20% of total expenditures for the previous fiscal year, please enclose a statement explaining your high administrative expenses. Yes, it does exceed 20% (I have included an explanation) No, it does not exceed 20%   4. List of corporate donors ($200 or more) Sent by Received by AFCC to be completed by AFCC   5. Project or program budget Sent by Received by AFCC to be completed by AFCC     I certify that the aforementioned and enclosed information is complete and accurate.   Name (person to contact if we have questions) Title Date Home telephone number (Mandatory - this number will be kept private and only be used in case of an emergency) Work telephone number Our application may not be submitted electronically. After you have completed the application, please click the gray bar, print it out, sign it, enclose additional information (1-5), and mail to Andrade Faxon Charities for Children, PO Box 3305, So. Attleboro, MA 02703.