KSBCF GRANT APPLICATION

Requirements for submission of grant requests:

All requests for KSBCF funding must be submitted through the grant application.

• Application Deadline: Requests must be submitted by April 1 or October 1 for consideration.
• You may submit a letter with additional information concerning your grant.
• Grant applicants will be notified of approval/denial of funding.

INDIVIDUAL APPLICANT

Name: ______________________________________________ Birth Date: _____ / _____ / _____

Address: ________________________________________________________________________

City: _____________________________________ State: ______________ Zip: ______________

Phone: (home)____________________(work)____________________(cell)___________________

E-mail address: ___________________________________________________________________

Is the applicant a student?: _________ School attending:__________________________________

Name of parent/guardian (if applicable): ________________________________________________

ORGANIZATIONAL APPLICANT

Contact: __________________________ Executive Director/Administrator:___________________

Organization: ____________________________________________________________________

Address: ________________________________________________________________________

City: _____________________________________ State: ______________ Zip: ______________

Phone:_____________________ Fax: ____________________ Website: ____________________

E-mail address: ___________________________________________________________________

Is the organization a 501(c)3?: _____ If so, please provide Federal ID number :________________

Number of employees: _________________ Annual operating budget: ______________________

Services provided: ________________________________________________________________

_____________________________________________________________________

Mission statement: _______________________________________________________________

Type (i.e. adults, children, teens, elderly) and scope (annual number served) of population served:

_______________________________________________________________________________

Dollar amount requested: $____________________ Date needed: _________________________

Purpose of the Grant:

(Please be as detailed as possible - include a description and itemization of costs. If grant is for education, provide the name of the institution. It the grant is for assistive technology, provide the name of the company from which the equipment is to be purchased.)

_____________________________________________________________________

_______________________________________________________________________________

Has funding been requested from any Kentucky state office, department, or agency? __ YES __ NO

If yes, what is the status?:  ___ Pending    ___ Funded (Amount $_________)    ___ Not Funded

To whom was the request made: ____________________________________________________

List other organizations or agencies to which the same request pending:

_______________________________________________________________________________

I hereby state that I answered the above information accurately and to the best of my ability.

Signature of Applicant: ________________________________________ Date: ______________


Please submit this application to:

Kentucky School for the Blind Charitable Foundation
Attn: Grant Review Committee
214 Haldeman Avenue
Louisville, KY 40206

Fax: (502) 897-3194
Email: contactus@ksbcf.org
Phone: (502) 897-3990

OFFICE USE ONLY

Date Application Received:__________________ Board Action:___________________________

Remarks:_______________________________________________________________________