Application

ONLINE GRANT APPLICATION

Grant Application

General Information

Name of Organization(Required)

Organization Address(Required)
Street Address Address Line 2 City State / Province / Region ZIP Code

Project Address (must be located in North Carolina to be considered for funding)(Required)
Street Address Address Line 2 City State ZIP Code

County(Required)

Website or Main Social Media

Contact Person for Application

Name(Required)
First Last

Title(Required)

Telephone(Required)

Email(Required)

Project Information

Title of Project(Required)

Amount Requested: $(Required)

Total Project Cost: $(Required)

Description of Project (use, purpose and plan)(Required)

Is this property listed on the National Register of Historic Places?(Required)

Yes

No

Who have you consulted with at the State Historic Preservation Office (SHPO)?(Required)

Find Your SHPO Contact Here:

Have you received a grant previously from the Foundation?(Required)

Yes

No

When did you receive the previous grant?(Required)

What other funds have been committed or are under consideration for this activity?

Committed Funding

Describe any committed funding for this project, including the source(s) of the funding and the specific amount(s).

Pending Funding

Describe any pending funding for this project, including the source(s) of the funding and the specific amount(s).

Future Funding Plans

Describe any future fundraising plans related to this project.

Financial Resources

Beginning of Fiscal Year (mm/yyyy)(Required)

End of Fiscal Year (mm/yyyy)(Required)

Current Organizational Budget $(Required)

Total Organizational Assets $(Required)

Total Organizational Endowment $

Total Current Fund Balances $

Income Last Two Years $(Required)

Expenditures Last Two Years $(Required)

Primary Source of Income(Required)

Human Resources

Number of Board Members(Required)

Number of Volunteers Involved(Required)

Number of Paid Staff(Required)

Full-time Staff(Required)

Part-time Staff(Required)

Attachments

Cover Letter describing organization and more in depth information about the project(Required)
Max. file size: 6 MB.

Current Operating Budget and Project Budget (including income sources & expenditures based on recent)(Required)
Max. file size: 6 MB.

Most Recent Federal Tax Determination Letter(Required)
Max. file size: 6 MB.

List of Board Members and Addresses(Required)
Max. file size: 6 MB.

Most Recent Audited Financial Statements(Required)
Max. file size: 6 MB.

Picture(s) of Property if Applicable

Drop files here or

Max. file size: 6 MB, Max. files: 4.

This applicant warrants that it has not been determined to be a private foundation by the Internal Revenue Service; The Marion S. Covington Foundation will be immediately notified if notice of such a determination ensues. The applicant will act as the responsible fiscal agent for any funds received.

Printed Name(Required)

Title(Required)

Date
MM slash DD slash YYYY

Signature of Board Chair or Chief Executive(Required)

Title

Date
MM slash DD slash YYYY