T H E R I V E R S I D E C H U R C H

THE SHARING FUND COMMITTEE

490 Riverside Drive

New York, NY 10027

REQUEST FOR FUNDS

Date:

Indicate the Fund targeted for this application:

Sharing Fund

Densford Fund

Indicate type of support you are seeking:

Project Support

General Operating Support

Full name of Project for which funds are sought, if applicable, and date and/or timeline for use of funds:

B)	Sponsoring Organization:

Organization Name:

Street address:

E-mail address:

Telephone number:

Contact Person: The Committee will acknowledge receipt of your grant request via email, so please provide a valid email address.

Name:

Title:

E-mail address:

Telephone number:

Name of person or organization who told you about the Sharing Fund and their contact information, if available:

C)	Amount of Grant Request (in US dollars):

Note: Sharing Fund requests may not exceed $5,000. Densford Fund requests should be $10,000 or less.

D)	Funding History with The Riverside Church:

Has your group ever received a Sharing Fund and/or Densford Fund grant? Yes No

If yes, please provide:

Date of Grant:

Project Title.

E)	Organizational Description:

Provide a statement of purpose or mission for the Sponsoring Organization, including the date of establishment and the total number of individuals served by its mission.

Briefly describe the Organization’s programs and activities.

F)	Not-for-Profit Status:

Is the Sponsoring Organization is a 501(c)(3) corporation or an equivalent type of tax exempt entity?
Yes No

If it is not, please note whether the Sponsoring Organization will work with a certified not-for-profit entity (e.g., an NGO or church) that will act as the fiscal conduit to receive funds on behalf of the Sponsoring Organization solely for the benefit of the Sponsoring Organization.

Please attach a copy of your not-for-profit / tax-exempt certification, or if appropriate, a copy of the fiscal conduit’s certification and letter from them attesting to their agreement to work with you and on your behalf.

G)	Project / Organization Specifics:

If you are requesting project support, the following questions apply to the Project. If you are requesting general operating support, they apply to the Sponsoring Organization.

What needs are being addressed?

What needs will the requested funds address?

How did this project originate?

What is the start date of this initiative?

What is the program strategy or plan of implementation to achieve the project’s goals and objectives?

What long-term funding strategies will sustain this project / organization?

H)	Personnel: (attach sheets as necessary)

Members of the Board of Trustees / Directors of the Sponsoring Organization (include titles and principal affiliations):

Name and credentials of Executive Director of the sponsoring organization:

For requests for project support, indicate the names and credentials of project staff:

I)	Financial Information:

On appended sheets, provide a statement covering the most recent fiscal year for the Sponsoring Organization, including both expenses and sources of income.

Please provide complete and detailed information about total funds currently available to the Sponsoring Organization, including a list of any grantors.

Budget for the organization’s current year.

If request is for project support, provide a project budget in addition to the current year’s Organization budget or annual statement, including the annual starting and ending dates.

Please provide dates/timeline for use of funds.

What are the current sources of funding available for this project?

Are any other grant applications pending?

Other means to raise necessary funds?

J)	Other Information:

Please include any other information relevant to your application that would assist the Committee in understanding the Project or Organization.

Please attach here two letters of support from persons or entities not directly affiliated with your Organization and/or email addresses of people who may support your project.