Angel Tear Ministries - Concordia Lutheran Ministries

Official Name of organization applying for grant*

Tax Identification Number*

Organization Mailing Address*

Phone Number

Web Address*

Executive Director*

Contact Person/Title (if different that Executive Director)

Contact Person Email Address*

Does the organization applying have 501(c)3 tax exempt status?*

Yes

Does you have any affiliation with the Lutheran Church - Missouri Synod?

Yes

Is applicant a church body with exempt status?*

Yes

Year of organization's founding?*

Have you received Angel Tear funds for this project before, or is it a new project?*

Please choose the financial category of your project application*

Small Grants(up to $10,000) - up to 30 available

MediumGrants(up to $10,00 - $25,000) - up to 25 available

Large Grants($25,001 +) - limited

Organization's Vision Statement*

Organization's Mission Statement*

Geographic Area & Population Served*

Project Name*

Project Purpose(in 100 Words or less)*

Amount Requested*

Total Project Budget*

*It is the preference of the Concordia Lutheran Ministries Foundation not to award grants that excess of 50% of your project budget.

Project Goals(3 Maximum)*

Grant Project Start Date*

Grant Project Finish Date*

Geographic Area & Population Served by this Project/Program*

I CERTIFY, TO THE BEST OF MY KNOWLEDGE, THAT: 1. The tax-exempt status of this Organization is in effect, 2. This Organization does not support or engage in any terrorist activity, and 3. if a grant is awarded to this Organization, the proceeds of that grant will not be distributed to or used to benefit any organization to an individual for any unlawful purpose.

Your Full Name (this constitutes your binding electronic signature)*

Today's Date*

Your Email Address*

Please, attach the following as either Microsoft Word or Adobe PDF files:

Grant Request Narrative (not to exceed 3 pages)*

Drop files here or

Max. file size: 50 MB, Max. files: 3.

Narrative must include: A. Describe in detail the project, purpose for the project, and funding needs. B. Project time frame showing start and end dates. C. Describe how the project/program will be evaluated through measurable outcomes. D. Include a detailed project budget showing income and expenses.

Copy of IRS Determination of 501(c)(3) tax exempt status*

Max. file size: 50 MB.

Copy of the most recent 990 (if your organization is not required to file a 990 or Audited Financials, please attach a word to notepad document explaining that)

Max. file size: 50 MB.

Most recent Audited Financial Report(if your organization is not required to file a 990, or Audited Financials, please attach a word or notepad document explaining that)*

Max. file size: 50 MB.

Roster of Board of Directors and Key Staff Members*

Max. file size: 50 MB.

Current Operating Budget Summery*

Max. file size: 50 MB.

Where did you hear about the Angel Tears Ministries grant program?

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