Application for Legacy Hall of Fame Grant

Please note, you can use “Save and Continue” at the bottom to come back to your application later. However, you will have to reattach any documents.

Legacy Hall of Fame Fund Grant Application

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Email

This field is for validation purposes and should be left unchanged.

These initial 4 questions will help determine whether your organization and proposal are eligible for the Legacy Hall of Fame Grant. The application questions will not open if answered incorrectly.

1. Are you applying on behalf of a 501(c)(3) nonprofit, a tax-exempt organization, a BCF Affiliate, or a BCF Component Fund?*

YES

NO

2. Does your project serve Bartlesville?*

YES

NO

3. Has your project started more than 1 month ago?*

YES

NO

4. Will your project be complete within 1 year of receiving BCF grant funding? (Fall grant awards are paid in December.)*

YES

NO

YOUR ORGANIZATION

Organization Name:*

Organization Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country

Organization Website:

Tax ID Number:*

Nine-digit number issued by the IRS. If you are applying on behalf of a component fund of the BCF, please type the BCF's tax ID number which is 731575838.

Organization Contact (person responsible for grant application):*

Contact Phone Number:*

Contact Email:*

Enter Email Confirm Email

W-9:*

Accepted file types: pdf, Max. file size: 16 MB.

If you are applying on behalf of a component fund of the BCF, please upload a blank form.

Solicitor Certificate of Registration with the OK Secretary of State:*

Accepted file types: pdf, Max. file size: 16 MB.

This should be your most recent filing to show your organization is registered as a solicitor in the state of Oklahoma. If you are applying on behalf of a BCF component fund, or are exempt from this requirement in the state of Oklahoma, please provide your exemption letter or upload a document with "exempt" typed in text.

First Page of Most Recent 990:*

Accepted file types: pdf, Max. file size: 16 MB.

The first page of your 990 includes your organization's name, filing year, tax-exempt status, and Part 1 and 2 (items 1-22). If you are applying on behalf of a component fund of the BCF, or are exempt from this requirement, please upload a blank form.

Would you like the BCF to share your project with other BCF fundholders?*

Yes

No

Type of Grant Requested (see Grant Guidelines above):*

Project/Program

Capacity Building

Seed Money

Request Name:*

The title of your project or request.

Project Budget

Itemized Project Expenses*

Item:

Expected Cost:

 

Add Remove

Be as specific as possible, and use the "+" to add more lines. Your "Expected Costs" should add up to the total cost of your project.

Total Project Cost:*

This should be the total of the costs listed above.

Grant Amount Being Requested (not to exceed $2,500):*

Please enter a number from 0 to 2500.

This field is hidden when viewing the form

Date When Funds will be Needed:

Month

Day

Year

Anticipated Project Start Date*

Month

Day

Year

Keep in mind that awardees are paid in December.

How Will These Grant Dollars be Used?*

Your explanation should include the specific expense item or items for which the grant dollars would be used as listed above.

Anticipated Funding from Other Sources:*

Source:

Amount:

 

Add Remove

Be as specific as possible, and use the "+" to add more lines. "Grant Amount Being Requested" + "Anticipated Funding from Other Sources: = "Total Project Cost"

NARRATIVE

Please tell us about your proposal by answering the following questions. Each answer is limited to 1500 characters.

1. Provide a brief description of your organization and its mission.*

2. Describe the need for your project, including how the need was determined.*

3. Describe the target population of your project and the expected numbers to be served.*

4. Describe your project and how it serves Bartlesville.*

5. Describe your expected outcomes.*

6. Describe your project timeline and process for implementation.*

7. How will you evaluate and measure the success of your project?*

8. How will you sustain this project in the future?*

9. Describe how your organization is uniquely qualified to deliver this project and how you are collaborating with other organizations.*

Supplemental Attachment: Graphics, such as photos and charts, are encouraged to illustrate data and help reviewers visualize your project or product. Upload in pdf format.

Accepted file types: pdf, Max. file size: 16 MB.

Using no more than three typed pages of Times New Roman 12pt font, answer the following questions, then upload below. Remember to include the questions as section headings:

1. A brief description of your organization and its mission.
2. A definition of the need, including how the need has been determined.
3. The targeted population (Include specific numbers that will be served, when applicable).
4. A description of the project and how it serves Bartlesville.
5. Your expected results.
6. Your timetable and process for achieving results.
7. How you will evaluate and measure the success of your proposal?
8. How will you sustain this program or project in the future, if applicable?

This field is hidden when viewing the form

Narrative Attachment*

Accepted file types: pdf, Max. file size: 16 MB.

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