2013 Grant Application

Fill out this form completely. When finished, click the Submit button to send it to our committee for processing. Your application is not submitted to us until you click Submit. Fields marked with an Asterisk (*) are required. Please note that you are not able to save this form and work on it at a later date.

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Organization Name:*


Contact Information:

Primary Contact Name:*


Address:*


City:*
State:*
Zip:*




Phone Number:*


Email Address:*


Web Site:*

Grant Details:

Requested Amount:*


Past Grants:

Dates and amounts of any grants, sponsorships or product donations received from New Belgium within the last three years
Organization Information:

One Percent for the Planet:*

If you are not a member of 1% for the Planet, click here to apply.

Program Area:*

If your organization’s mission or purpose does not fit into these categories, you do not qualify for a grant.

Description of the organization, including Mission and most recent accomplishments:*


Please state the project name, purpose and who/what will benefit from this project:*


Please describe the project strategy:*


Please describe how the funds will be used:*


What impact will the project have and how will the impact be measured?*


Please include a budget for the project that identifies support from other grantor (if any). Distinguish between “already secured” and proposed” support from other grantors.*

Volunteer Information:

Number of volunteers and number of volunteer hours contributed per year:*


Would you like support from New Belgium volunteers?:*


If so, please enter your volunteer coordinator's contact information:

Required Files:

Please attach a copy of your IRS 501(c) (3) Determination Letter:*
 

Financial information-Please attach a copy of your organization/project’s last fiscal year financial statements including a statement of assets, liabilities, expenses, and revenues:*
 

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