Washington County Healthy Living Fund | Bartlesville Community Foundation

The Washington County health Living Fund seeks to encourage organizations or causes that work to prevent and/or treat negative external influences to human bodies and minds. the funds will be available for specific programs, not operating expenses. Examples include but are not limited too: teaching prevention, rehabilitating criminal offenders, assessing and treating adolescents, promoting healthy living.

Grant requests submitted to this fund should not exceed $10,000 and cannot be more than 50% of the total project cost.

Washington County Healthy Living Fund Grant Application

Organization Name:(Required)

Organization Address:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Organization Website:

Tax ID Number(Required)

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):(Required)

Contact Phone Number:(Required)

Contact Email:(Required)

Enter Email Confirm Email

W-9(Required)

Accepted file types: pdf, Max. file size: 50 MB.

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

Solicitor Certificate of Registration from the OK Secretary of State(Required)

Accepted file types: pdf, Max. file size: 50 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:(Required)

Accepted file types: pdf, Max. file size: 50 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.

Project/Program Name(Required)

Project Budget

Itemized Project Expenses(Required)

Item:

Expected Cost:

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:(Required)

This should be the total of the costs listed above.

Grant Amount Being Requested:(Required)

Please enter a number from 0 to 10000.

Ideally, this should be the cost of one (or more) of the items listed above. Remember, the amount of the request cannot exceed $10,000.

Date When Funds Will Be Needed:(Required)

How Will These Grant Dollars Be Used?(Required)

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(Required)

Source

Amount

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

How many individuals do you anticipate will benefit from this project?(Required)

Please list any other organizations in this area who are involved in the same or similar project.(Required)

Use the "+" to add more lines.

Please provide a narrative about the project and the benefits expected.(Required)

CAPTCHA

(PLEASE NOTE: When you choose "Save and Continue Later", you will be taken to this grant's home page. You will then need to scroll to the bottom and enter your email address.)

Comments

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