{"id":71,"date":"2020-09-17T21:43:54","date_gmt":"2020-09-17T21:43:54","guid":{"rendered":"http:\/\/lakecountycommunityfoundation.net\/?page_id=71"},"modified":"2025-08-04T20:51:43","modified_gmt":"2025-08-04T20:51:43","slug":"application","status":"publish","type":"page","link":"https:\/\/lakecountycommunityfoundation.net\/?page_id=71","title":{"rendered":"Grant Application Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"71\" class=\"elementor elementor-71\">\n\t\t\t\t<div class=\"elementor-element elementor-element-13a52e6b e-flex e-con-boxed e-con e-parent\" data-id=\"13a52e6b\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-458aeaa8 elementor-widget elementor-widget-text-editor\" data-id=\"458aeaa8\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<hr class=\"wp-block-separator has-css-opacity\"\/>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-73eb3af e-flex e-con-boxed e-con e-parent\" data-id=\"73eb3af\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-6112780 elementor-widget elementor-widget-wpforms\" data-id=\"6112780\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"wpforms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-de044f8c-779a-42c7-917d-7799f202bd60\" id=\"wpforms-239\"><form id=\"wpforms-form-239\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"239\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F71\" data-token=\"f977c84d87cd720cfb7c74489e6f28c0\" data-token-time=\"1782258841\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-239-field_1-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-239-field_1\">Date<\/label><input type=\"text\" id=\"wpforms-239-field_1\" class=\"wpforms-field-medium\" name=\"wpforms[fields][1]\" ><\/div><div id=\"wpforms-239-field_3-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"3\"><label class=\"wpforms-field-label\">Please Check one<\/label><ul id=\"wpforms-239-field_3\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-239-field_3_1\" name=\"wpforms[fields][3][]\" value=\"New Request\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-239-field_3_1\">New Request<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-239-field_3_2\" name=\"wpforms[fields][3][]\" value=\"Renewal Request\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-239-field_3_2\">Renewal Request<\/label><\/li><\/ul><\/div><div id=\"wpforms-239-field_5-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-239-field_5\">ORGANIZATION NAME<\/label><input type=\"text\" id=\"wpforms-239-field_5\" class=\"wpforms-field-medium\" name=\"wpforms[fields][5]\" ><\/div><div id=\"wpforms-239-field_6-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-239-field_6\">Address, City, State, Zip Code<\/label><input type=\"text\" id=\"wpforms-239-field_6\" class=\"wpforms-field-medium\" name=\"wpforms[fields][6]\" ><\/div><div id=\"wpforms-239-field_7-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-239-field_7\">County, Website, Phone #, Email<\/label><input type=\"text\" id=\"wpforms-239-field_7\" class=\"wpforms-field-medium\" name=\"wpforms[fields][7]\" ><\/div><div id=\"wpforms-239-field_8-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-239-field_8\">EXECUTIVE DIRECTOR OR BOARD CHAIR (name, title, email)<\/label><input type=\"text\" id=\"wpforms-239-field_8\" class=\"wpforms-field-medium\" name=\"wpforms[fields][8]\" ><\/div><div id=\"wpforms-239-field_9-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-239-field_9\">Counties where services are provided:<\/label><input type=\"text\" id=\"wpforms-239-field_9\" class=\"wpforms-field-medium\" name=\"wpforms[fields][9]\" ><\/div><div id=\"wpforms-239-field_10-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-239-field_10\">Employer ID number (EIN), year organization established<\/label><input type=\"text\" id=\"wpforms-239-field_10\" class=\"wpforms-field-medium\" name=\"wpforms[fields][10]\" ><\/div><div id=\"wpforms-239-field_11-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-239-field_11\">Number of paid employees, Number of volunteers, Number of board members, Number of board meetings per year.<\/label><input type=\"text\" id=\"wpforms-239-field_11\" class=\"wpforms-field-medium\" name=\"wpforms[fields][11]\" ><\/div><div id=\"wpforms-239-field_12-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-239-field_12\">ORGANIZATION FINANCIAL INFORMATION, Budget for current year, organization expenditure total for last year, Organization revenue total for last year.<\/label><input type=\"text\" id=\"wpforms-239-field_12\" class=\"wpforms-field-medium\" name=\"wpforms[fields][12]\" ><\/div><div id=\"wpforms-239-field_13-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-239-field_13\">From last year&#039;s revenue sources, please list the five single largest contributors and amounts provided. (Contributors include specific individuals, agencies, businesses, foundations, or other groups. Individuals may be listed as anonymous.)<\/label><textarea id=\"wpforms-239-field_13\" class=\"wpforms-field-medium\" name=\"wpforms[fields][13]\" ><\/textarea><\/div><div id=\"wpforms-239-field_14-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-239-field_14\">Please list grant applications to LCCF and amounts awarded during the past three years.<\/label><textarea id=\"wpforms-239-field_14\" class=\"wpforms-field-medium\" name=\"wpforms[fields][14]\" ><\/textarea><\/div><div id=\"wpforms-239-field_15-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-239-field_15\">PROJECT CONTACT PERSON - Name, title, phone, email<\/label><input type=\"text\" id=\"wpforms-239-field_15\" class=\"wpforms-field-medium\" name=\"wpforms[fields][15]\" ><\/div><div id=\"wpforms-239-field_16-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-239-field_16\">Project description (one sentence)<\/label><input type=\"text\" id=\"wpforms-239-field_16\" class=\"wpforms-field-medium\" name=\"wpforms[fields][16]\" ><\/div><div id=\"wpforms-239-field_17-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-239-field_17\">How many persons will benefit directly from the project?<\/label><input type=\"text\" id=\"wpforms-239-field_17\" class=\"wpforms-field-medium\" name=\"wpforms[fields][17]\" ><\/div><div id=\"wpforms-239-field_18-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-239-field_18\">In what counties will services be provided through this project?<\/label><input type=\"text\" id=\"wpforms-239-field_18\" class=\"wpforms-field-medium\" name=\"wpforms[fields][18]\" ><\/div><div id=\"wpforms-239-field_19-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-239-field_19\">TOTAL PROJECT BUDGET \/ TOTAL REQUESTED<\/label><input type=\"text\" id=\"wpforms-239-field_19\" class=\"wpforms-field-medium\" name=\"wpforms[fields][19]\" ><\/div><div id=\"wpforms-239-field_20-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-239-field_20\">Other proposed sources of funding and amounts for each. (Please note if funding is secured with &quot;yes&quot; or &quot;no&quot;.<\/label><textarea id=\"wpforms-239-field_20\" class=\"wpforms-field-medium\" name=\"wpforms[fields][20]\" ><\/textarea><\/div><div id=\"wpforms-239-field_22-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-239-field_22\">NARRATIVE, please answer the following questions. <\/label><input type=\"text\" id=\"wpforms-239-field_22\" class=\"wpforms-field-medium\" name=\"wpforms[fields][22]\" ><\/div><div id=\"wpforms-239-field_23-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-239-field_23\">Describe your organization. What is your mission?<\/label><textarea id=\"wpforms-239-field_23\" class=\"wpforms-field-medium\" name=\"wpforms[fields][23]\" ><\/textarea><\/div><div id=\"wpforms-239-field_24-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-239-field_24\">What does your project address: What critical community problem needs to be fixed?<\/label><textarea id=\"wpforms-239-field_24\" class=\"wpforms-field-medium\" name=\"wpforms[fields][24]\" ><\/textarea><\/div><div id=\"wpforms-239-field_25-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-239-field_25\">How will you do it? What are the specific activities to be supported?<\/label><textarea id=\"wpforms-239-field_25\" class=\"wpforms-field-medium\" name=\"wpforms[fields][25]\" ><\/textarea><\/div><div id=\"wpforms-239-field_26-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-239-field_26\">Who is responsible for your project? Briefly describe your project leaders and the role that each will play. <\/label><textarea id=\"wpforms-239-field_26\" class=\"wpforms-field-medium\" name=\"wpforms[fields][26]\" ><\/textarea><\/div><div id=\"wpforms-239-field_27-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"27\"><label class=\"wpforms-field-label\" for=\"wpforms-239-field_27\">How will you measure results?<\/label><textarea id=\"wpforms-239-field_27\" class=\"wpforms-field-medium\" name=\"wpforms[fields][27]\" ><\/textarea><\/div><div id=\"wpforms-239-field_28-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"28\"><label class=\"wpforms-field-label\" for=\"wpforms-239-field_28\">CONCLUSION - Why do you think this project fits &quot;People helping people create a better Lake County by giving where they live&quot;?  Why does it matter to your community?<\/label><textarea id=\"wpforms-239-field_28\" class=\"wpforms-field-medium\" name=\"wpforms[fields][28]\" ><\/textarea><\/div><div id=\"wpforms-239-field_29-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"29\"><label class=\"wpforms-field-label\" for=\"wpforms-239-field_29\">With my signature (printed name will count as signature) and date, I certify the following :(1) The above information is correct; (2) I am authorized by the governing board of this organization to submit this grant application to the Lake County Community Foundation; (3) this organization is in good standing with the IRS, retains its 501 (c)(3) tax-exempt status and is further classified as a public charity and not a private foundation; (4) this organization does not discriminate on the basis of race, religion, sexual preference, physical curcumstances or national origin. <\/label><input type=\"text\" id=\"wpforms-239-field_29\" class=\"wpforms-field-medium\" name=\"wpforms[fields][29]\" ><\/div><div id=\"wpforms-239-field_30-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"30\"><label class=\"wpforms-field-label\" for=\"wpforms-239-field_30\">Required - ONE complete package that includes: application summary and narrative, detailed project budget, including revenues and expenditures, list of board of directors with affiliations and phone numbers and organization 501(c)(3) determination letter from the IRS.  Click &quot;submit&quot; to email the application or print it and mail it to:Lake County Community Foundation Attn: LCCF Board Member, 126 North E Street, Lakeview, OR 97630<\/label><input type=\"text\" id=\"wpforms-239-field_30\" class=\"wpforms-field-medium\" name=\"wpforms[fields][30]\" ><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-recaptcha-container wpforms-is-recaptcha wpforms-is-recaptcha-type-v2\" ><div class=\"g-recaptcha\" data-sitekey=\"6LeqcBIhAAAAADcBtBLmKjdS8LKOUhHCzGpz9bEL\"><\/div><input type=\"text\" name=\"g-recaptcha-hidden\" class=\"wpforms-recaptcha-hidden\" style=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\" data-rule-recaptcha=\"1\"><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"239\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/lakecountycommunityfoundation.net\/index.php?rest_route=\/wp\/v2\/pages\/71\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-239\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img decoding=\"async\" src=\"https:\/\/lakecountycommunityfoundation.net\/wp-content\/plugins\/wpforms-lite\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Please enable JavaScript in your browser to complete this form.DatePlease Check one New Request Renewal Request ORGANIZATION NAMEAddress, City, State, Zip CodeCounty, Website, Phone #, EmailEXECUTIVE DIRECTOR OR BOARD CHAIR (name, title, email)Counties where services are provided:Employer ID number (EIN), year organization establishedNumber of paid employees, Number of volunteers, Number of board members, Number of&#8230;<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-71","page","type-page","status-publish","hentry"],"aioseo_notices":[],"aioseo_head":"\n\t\t<!-- All in One SEO 4.9.8 - 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