Impact100 Grant Application

For assistance or questions about the application process please email [email protected]

Grant Application 2024

Applicants may apply for the $100,000 Impact grant or the Residual grant but not both in the same year. Please complete the form below to apply for either grant from Impact100 Owensboro. Fields marked with an asterisk * require an entry.

This online grant application will close at 5pm on May 31, 2024.

You are able to save your application and return to finish it within 30 days. Simply click save at the end of the form and a link will be sent to the email you provided.

If you have questions regarding your application please email [email protected].

View the example budget forms that are referenced in Section Six. If your existing financials are in a similar form as the example forms, you may submit those instead

SECTION ONE
Are you applying for a $100,000 Grant or for a $34,000 Residual Grant?*
- $100,000 Grant
- $34,000 Residual Grant
Eligibility Requirements*
By checking each of the following boxes, I acknowledge and attest to Impact100 Owensboro’s grant eligibility requirements:
This nonprofit organization is an active 501(c)(3) organization.
Consent*
This nonprofit organization is located in and serves residents of the Greater Owensboro Area, and the proposed project will be implemented in and serve residents of the Greater Owensboro Area.*
Consent*
This nonprofit organization is in good standing and has current registration with the State of Kentucky Secretary of State.*
Consent*
This nonprofit organization does not discriminate based on religion, race, ethnicity, sexual orientation or gender. Impact100 grants will not be utilized for partisan, legislative, political, or religious activities.*
Consent*
This grant will not fund general operating expenses or overhead. However, funds can be used for operating expenses if they are relative to new programming, such as a new staff person.*
Consent*
This grant will not fund payment of projects already completed nor repayment of previously incurred debt.*
Consent*
This grant project/program will not require participation in activities of a particular faith, denomination or religion in order to benefit from the project or program.*
If an employee or board member may personally benefit from this grant project, please disclose the potential conflict of interest.
Brief Project Summary*
Briefly describe your grant project including how Impact100’s grant funds will be spent. (If selected as a finalist, this project summary may be used in communications to our membership at large.)
Organization Information
Applicant Organization (Legal Name)*
Doing Business As
Previous Name, if changed
Address*
Street Address City State ZIP Code
County*
Website
Phone*
IRS Name, as listed on 501(c)(3) letter*
IRS Letter Date*
Month
Day
Year
Employer Identification Number (EIN)*
Name of Executive Director*
First Last
Executive Director Email*
Executive Director Phone*
Is the Primary Contact person for this request different than the Executive Director?*
Primary Contact is the person who should receive all communications related to the grant cycle including questions about the grant, scheduling site visits, coordinating finalist events etc.
- Yes
- No
Contact Name*
First Last
Contact Title*
Contact Phone*
Contact Email*
Organization’s Budgeted Expenses for Current Year*
Endowment Size*
Organization’s Major Funding Sources*
Organization’s Affiliation and/or Accreditation Body
Check all that apply
- United Way
- Fine Arts Fund
- Better Business Bureau
- Chapter of national or regional organization
- Other
- None
Please specify national or regional organization
Please specify other affiliation and/or accreditation
Have you previously received an Impact100 Grant?*
Please list the year and amount of each Impact100 Grant received.
Example would be: 2021 – $100,000
Grant Request Information
Program/Project Title*
Focus Area – rearrange the list below by dragging into a sequence where the first one aligns best with your project and the last one aligns least.
Determine the Focus Area that best aligns with the nature and objective of your proposal. Rank the focus areas listed below. Arrange the focus area in a sequence by dragging/rearranging the tiles below where the first one aligns best with your project and the last one aligns least.
- Arts and Culture
- Education
- Environment & Recreation
- Family
- Health and Wellness
Type of Grant Request*
Check all that apply
- Capital Expenditures
- Programming
- Endowment
- Research & Development
- Collaborative Project/Program
Total Budget for this Program/Project*
Note: Your program/project budget must equal or exceed $100,000 or $34,000 if applying for the residual grant.
Community/Counties to be served by this Program/Project*
Brief demographic description of population served by this Program/Project*
Potential Number to be served by this Program/Project*
SECTION TWO – Profile of Organization
Give a brief summary of organization’s history*
Share the organization’s vision/mission*
Give a brief description of current programs/projects and activities*
Describe organization’s constituency and geographic region of service*
SECTION THREE– Proposed Program/Project Description
Describe the proposed program/project, including at least: (1) Goals or objectives of the proposal – consider using SMART objectives (2) Activities to accomplish the program/project (Note: Indicate whether this is a new or an expanded or modified program/project; if expanded or modified, identify how it increases your organization’s outreach.) (3) Timetable for implementation*
Provide a Statement of community need with supporting evidence and describe why your organization is especially qualified to meet this need.*
Describe the impact of this program/project on the community; include how this program/project is transformational to the Greater Owensboro Area*
Share how this proposed program/project could complement or enhance the work/efforts of other organizations to respond to the needs you have identified*
SECTION FOUR – Evaluation/Assessment
How will you define and measure the success/impact of your program/project and how will the results be shared?*
SECTION FIVE – Program/Project Funding Plans
List other funders to which this current proposal has been or will be submitted. For each, indicate the amount requested and the status of the request. For example, Submitted, Pending, Funded, Declined. If funded, specify the amount of funding granted*
What other income, if any, do you anticipate for this project? If any, describe. For example: (1) Earned revenue (2) In-kind support (3) Special events (4) Fundraisers (5) Other
Describe plans and specific sources for future/long-term funding and sources of sustainability.*
SECTION SIX – Required Financial Attachments
Items 1 – 6 must each be submitted and clearly identified. Please include the name of your organization in the file name for each attachment.

Note: If your existing financials are in a similar form as the example forms, they may be submitted instead.
If you have questions about these financial documents please reach out to the Grant Committee at [email protected].
(1) Submit Statement of Revenue/Support and Expenses for your organization’s most recently completed fiscal/calendar year, which includes Net Income/(Loss) (see example Form A).*
Accepted file types: pdf, Max. file size: 50 MB.
(2) Submit Balance Sheet for most recently completed fiscal year.*
This should include Assets, Liabilities, Equity.
Accepted file types: pdf, Max. file size: 50 MB.
(3) Provide your most recent, complete audit, review or compilation including notes. If the organization does not have a third-party report done, then send the most recent IRS Form 990.*
This should include Assets, Liabilities, Equity.
Accepted file types: pdf, Max. file size: 50 MB.
(4) Send the organization's budget for the current fiscal/calendar year including a column showing the organization’s year-to-date status (see example Form B).*
Accepted file types: pdf, Max. file size: 50 MB.
(5) Submit the Proposed Program/Project Budget for your entire project (see example Form C, or Form D for Capital Requests). If your project’s budget is greater than the grant amount, clearly indicate which portions will be funded by the Impact100 Grant. Also specifically indicate how you will fund the balance of the project.*
Accepted file types: pdf, Max. file size: 50 MB.
(6) Copy of cost estimates or quotes
Accepted file types: pdf, Max. file size: 50 MB.
(7) If there will be ongoing expenses associated with your project which will increase the organization’s operating budget by 20% or more, or if this is a new organization, provide pro forma project budgets for the next three years. The purpose of the pro forma is to show how the organization plans to sustain the project.(PDF format only)

Accepted file types: pdf, Max. file size: 50 MB.
SECTION SEVEN – Required Non-Financial Attachments
Please upload the following non-financial files (PDF format only.)
IRS letter of determination of 501(c)3*
Accepted file types: pdf, Max. file size: 50 MB.
List of Current Board Members*
Accepted file types: pdf, Max. file size: 50 MB.
Proof of good standing with the Secretary of State*
You may look up your standing at https://web.sos.ky.gov/bussearchnprofile/search.aspx
Accepted file types: pdf, Max. file size: 50 MB.
Letters of commitment from collaborating or supportive organizations, if appropriate
Drop files here or

Accepted file types: pdf, Max. file size: 50 MB.
Permission to Record and Grant Agreement
Permission to Video Site Visits to Share with the Entire Membership*
By clicking the box below, I grant Impact100 permission to record the site visit at my organization and to share the recording with all Impact100 members.
Yes, Impact100 may video record our site visit
Terms of Grant Agreement for Impact100 Owensboro*
(1) Applicant agrees that any grant received from Impact100 will be expended for the explicit purposes described in the grant proposal. In the event grant monies are to be allocated for any other purpose, agreement must be obtained from Impact100.
(2) If a grant is received, applicant agrees to credit Impact100 in the manner identified by Impact100 in any publications (including annual reports, newsletters) press releases, brochures, videotapes, and other publicity or public relations materials and presentations.
(3) Applicant agrees to put Yard Signs where visible during times designated by Impact100 throughout the year.
(4) Impact100 requires invoices for all money spent as indicated in the grant request. No funds are dispersed in advance.

I have read and understand the Terms of Grant Agreement, and, should a grant be received, agree to follow its terms and conditions.
Comments
This field is for validation purposes and should be left unchanged.

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Grant Application 2024

SECTION ONE

Organization Information

Grant Request Information

SECTION TWO – Profile of Organization

SECTION THREE– Proposed Program/Project Description

SECTION FOUR – Evaluation/Assessment

SECTION FIVE – Program/Project Funding Plans

SECTION SIX – Required Financial Attachments

SECTION SEVEN – Required Non-Financial Attachments

Permission to Record and Grant Agreement

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