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To be considered for a grant, complete the entire grant application form.
Items in Red are required fields.

Attach the following documents:
  • Fiscal Sponsorship Certification Form (if you are not tax exempt)
  • If relevant, two (2) estimates for any purchase and repair over $500
  • Detailed project / program budget
  • Detailed agency budget for current year
  • Current financial statements (balance sheet and operating statement)
  • Current list of Board of Directors
  • Copy of the Internal Revenue Service ruling or determination letter of status under section 501(c)(3) and 509(a) of the IRS Code
  • ("Control" click for multiple documents. File types allowed: .doc, .docx, .xls, .xlsx, .pdf)

Organization Identity
Organization Name:
  Address 1:
Address 2:
Year Established:
  Web Site:
Are You Tax Exempt?
Yes No
If Yes, attach copies of relevant Internal Revenue Service ruling or determination letters (see Select Files button above)
If not attached, please explain:
If you are not tax exempt, you must complete and attach the Fiscal Sponsorship Certification Form
Paid Employees:
What is the mission statement of your organization?
What is the target population and geographic area served?
Financial Information
Total Annual Budget of Organization:
Total Financial Support Received
Last Fiscal Year:

  From Memberships:
From Fund-raising Activities:
  From Foundations:
Individual Contributions:
  From United Way:
From Government Programs:
  From Corporations:
Are your financial records subject to an annual audit?
Yes No
  If yes, is a copy of audit available upon request?
Yes No
List previous grant applications to Racine Community Foundation during the last five years:
Application Date:
  Project / Program Title:
Amount Requested:
  Amount Received:
Need More?
Board President / Chair
First Name:
  Last Name:
Executive Director / CEO
First Name:
  Last Name:
Contact Person
First Name:
  Last Name:
  How did you become aware of RCF and its grant program?

If Other, please specify:
Project / Program Information
Type of Project / Program:

If Other, please specify:
  Project / Program Name:
Project / Program Total Cost:
  Amount Being Requested
from RCF (round to dollars):

Project / Program Start Date:
  Project / Program End Date:
Project / Program description including specific objectives:
How was need determined and how will the Project / Program respond
to this need?

Indicate your organization's special qualifications to address these needs:
List other groups addressing the same or related objectives and the extent of
your collaboration with them:

Describe your Project / Program evaluation plan. Be very specific about who will evaluate it, the expected completion dates for the objectives and the criteria for judging success:
How will your organization publicize RCF as a funding source?
(i.e. web site, press releases, brochures, etc.)

If the Project / Program is ongoing, please identify future funding sources for succeeding years or the duration of the project:
List other sources of support being approached for this Project / Program in
addition to Racine Community Foundation:
  Amount Requested:
Current Status:
  Need More?


We agree to use the funds received as outlined in this grant request.

We agree to include a link to Racine Community Foundation's website from our website within 30 days of receiving the grant.

We agree to list the Racine Community Foundation as a funding source on all printed materials such as flyers, programs, posters, advertisements, press releases, newsletters, brochures, and annual reports.

We agree to list the Racine Community Foundation as a funding source on all forms of social media that we are using such as facebook, twitter, etc.

We agree to include the Racine Community Foundation logo where applicable.

We agree to submit the Follow-up Report by the deadline date which is one month after the project / program is completed.

We agree to submit an accounting of all expenditures.

We agree to provide additional project / program or organization information as requested by the Racine Community Foundation.

By clicking Submit you indicate that you will fully comply with these Terms of Agreement.

Please do not complete this application until you have received notification from the Foundation that your letter of intent has been accepted. Thank you, RCF.