Grant Application - The Glenn & Carol Pearsall Adirondack Foundation

Applications only available and accepted between JULY 1 and AUGUST 31.

Each grant we receive must be reviewed to ensure it is complete, and can easily be summarized and categorized. As this is a very time consuming process, we greatly appreciate your attention following the format in the grant application below and staying within the limits set forth.

Additionally here are a few things to remember:

Our focus is on groups within the Adirondack Park that serve year-round residents of the Adirondack Park, though we do consider (and fund) groups based outside the park boundary whose primary impact of the grant will be within the Adirondack Park.
In general we do not fund capital campaign grants.
In general we do not fund grants that are solely for staff salary.
Receiving funding one year does in no way guarantee any future funding.

Who are you:
Organization Name*
Contact Person*
Contact Email*
Enter Email Confirm Email

This address will receive a confirmation email once the form is submitted and we may use this address for any follow-up communications.
Phone*
Address*
Street Address Address Line 2 City State ZIP Code
Federal Tax ID*

501(c)3 or other non-profit or public tax identification number. ex. 12-3456780
What are you trying to accomplish:
Quality of Life*
What aspect of quality of life in the Adirondack Park is your organization concerned with?
What do you propose to do:
How do you propose to address the issue you’ve identified?*
How much do you project the total project / program may cost?*
Please enter a number greater than or equal to 0.
How much are you requesting for this grant?*
Please enter a number greater than or equal to 0.
How will you use the funds?*
Please explain in one sentence how you are going to use any funds granted. (this brief summary helps us clearly understand the specific items / project / program for which you are requesting funds).
How will you measure your progress:
What do you hope to achieve with these funds (goals for this specific project)?*
Please list the stated goals (bullet points are acceptable)
Success Criteria*
What objective, measurable criteria will you use to determine the success or failure of this effort? (bullet points are acceptable)
Financial Snapshot – Overview
Start of Fiscal Year*
MM slash DD slash YYYY
End of Fiscal Year*
MM slash DD slash YYYY
Financial Snapshot – Revenue
Total Revenue $*
In USD, with decimal (ie. 1000.00)
For the following % fields, provide an approximate breakdown, where the total of all fields should equal 100%.
Membership / Admission Fees (%)
Annual Fundraising (%)
Contributions from Board Members (%)
Earned Income (%)
Government Funding (%)
Private Grants (%)
Withdrawl from endowment (%)
Other (%)
Total % Revenue
Description of Other income / revenue
Financial Snapshot – Assets
Total investable assets*
In USD. Bank accounts, endowments, etc. (ie 100,000.00)
Total Assets*
In USD. Including real property. (ie 100,000.00)
Financial Snapshot – Expenses
Total Expenses $*
In USD. (ie 10,000.00)
For the following % fields, provide an approximate breakdown, where the total of all fields should equal 100%.
Staff (total cost including benefits) (%)
Building (rent / mortgage) (%)
Administrative costs (phone, postage, copying, etc…) (%)
Programming (%)
Other (%)
Total % Expenses
Description of Other expense(s)
Name
This field is for validation purposes and should be left unchanged.

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Who are you:

What are you trying to accomplish:

What do you propose to do:

How will you measure your progress:

Financial Snapshot – Overview

Financial Snapshot – Revenue

Financial Snapshot – Assets

Financial Snapshot – Expenses