Service Grant Application

Thank you for your interest in ServeWyoming's Pro Bono Volunteer Network. Rather than cash grants, ServeWyoming facilitates grants of professional consulting services called "Service Grants." Awardees are granted the help of one of our pro bono volunteers for one area of need. The pro bono volunteer will work with your nonprofit for a short-term, specific project designed to build capacity within your nonprofit. Please review the grant criteria before you apply. Late applications will not be accepted. Failure to submit any of the supporting documents will result in an incomplete application, and you will not be eligible for consideration.

-- REQUIRED FIELDS ARE INDICATED WITH A * --

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* How many clients did your organization serve in 2011?

* How many clients did your organization serve in low income or poverty level households?

* Please indicate how many clients you served in the following areas:
    Disadvantaged children or youth served:


    Children of incarcerated parents served:


    Individuals Mentored:


    Number of clients who received independent living services:


    Number of community members who received disaster assistance:

* Please indicate how many volunteers and volunteer hours your organization received in 2011 in the following categories:
    Children (ages 0 - 18): #
Hours of Service:

    College Students (18 - up): #
Hours of Service:

    Baby Boomers (Born between 1946 - 1964): #
Hours of Service:

* Is your organization a 501(c)3 or is your organization in the process of becoming a 501(c)3?
Yes
No

* Has your organization submitted a 990 form to the IRS for the past three fiscal years?
Yes
No

* What is the geographic area and population your organization serves?

* In one paragraph, please summarize your organization's history and mission:

* What area(s) of expertise does your organization need from the Pro Bono Volunteer Network? (Multiple request ares must be related to one need. Requests that are unrelated to the same need will not be accepted.)
Finance and Accounting
Human Resources
Fund Development
Graphic Design
Marketing
Program Design and Evaluation
Non-Profit Management
Board Development
Strategic Planning
Legal Affairs
Information Technology...
Other (Please Explain)...

* NEEDS STATEMENT: Why do you need this Service Grant? Please tell us about your organization's need for this project and the help of a Pro Bono Volunteer.

* GOAL STATEMENT: Outline how the completion of the proposed projects will increase overall capacity (actions that improve nonprofit effectiveness) for your organization.

* How many hours do you estimate it would take a Professional Volunteer Consultant to complete this project? When would your organization be prepared to have the Consultant start?

* EVALUATION: Describe what method you will use to determine success and how you will measure the impact of the Service Grant. (For example, Quantitative and Qualitative Data/Success Stories)

* Please share how your organization has the internal resources necessary to move forward from the Consultant's work and execute the training and advice provided to you by the Professional Volunteer.

* If your organization does not receive this Service Grant, what will you do to find comparable help?

* Have you faxed or emailed your supporting documents to ServeWyoming at fax (307) 234-3438 or email Shelly@servewyoming.org?
    Operating budget:
Yes
No
    Profit and loss statement:
Yes
No
    Balance sheet:
Yes
No
    Tax exemption letter:
Yes
No
    List of current board members:
Yes
No

By providing the above requested information, the undersigned certifies that they are authorized to represent the organization applying for the grant, the information submitted is accurate, and the Chairman of the Board supports this application. I affirm that the typed name on the signature line is a valid signature. Initials.