Grant Request Form - Jensen Foundation

The Rick & Marg Jensen Family Foundation supports CRA registered charitable organizations that improve quality of life in Cranbrook and the East Kootenay. We give particular consideration to programs that create opportunities for children, youth, families, and people facing disadvantage.

Please answer each question as fully and concisely as possible. If a question does not apply, enter “Not applicable.” Submission of an application does not guarantee funding. All grants are subject to the eligibility and approval of the Rick & Marg Jensen Family Foundation.

Organization Information

Date of Request(Required)

Legal Name of Organization(Required)

Operating Name, if Different

CRA Approved Charity Registration Number(Required)

Without a valid CRA registration number, we are unable to process your application further.

Mailing Address(Required)

Community(Required)

Postal Code(Required)

Website

Primary Contact Person(Required)

Title or Position

Telephone(Required)

Email(Required)

How Many Years Has Your Organization Operated in Cranbrook or the East Kootenay?

Briefly Describe Your Organization's Purpose or Mission(Required)

What Communities or Geographic Areas Does Your Organization Serve?

Is Your Organization Governed by a Volunteer Board?(Required)

Yes

No

Number of Board Members

If Your Organization Is Affiliated With, Sponsored By, or Operates Under Another Organization, Provide Its Name

Enter "Not applicable" if none.

Program or Project

Name of the Program or Project for Which Funding Is Requested(Required)

Is This:(Required)

A new program or project

An existing program or project

An expansion of an existing program or project

A request for general organizational support

A capital or equipment purchase

Other

How Many Years Has the Program or Project Operated?

Proposed Start Date

Completion Date

By What Date Is a Funding Decision Required?

Program Description: Briefly Describe the Program or Project and the Activities That Will Be Undertaken(Required)

Community Need: What Community Need or Problem Will This Program or Project Address?(Required)

People and Communities Served: Who Will Benefit From the Program or Project?(Required)

Approximately How Many People Will Benefit?

How Was This Number Estimated?

In Which Community or Communities Do the Beneficiaries Live?

How Do Individuals Access or Become Eligible for the Program?

Are There Any Fees or Other Barriers to Participation?(Required)

No

Yes

Please Explain

Expected Results: What Difference Do You Expect This Program or Project to Make for the People Served?(Required)

How Will You Know Whether the Program or Project Was Successful?(Required)

Financial Information

Total Cost of the Program or Project(Required)

Enter amount in CAD.

Amount Requested From the Jensen Family Foundation(Required)

Organization's Contribution

Funding Confirmed From Other Sources

Funding Requested or Pending From Other Sources

Remaining Funding Required

If the Foundation Is Unable to Provide the Full Amount Requested, Could the Program or Project Proceed With Partial Funding?(Required)

Yes

No

Possibly

Please Explain

Describe Specifically How a Grant From the Foundation Would Be Spent(Required)

Proposed Use of Funding

Amount

Will Any Portion of the Funding Be Used for Administrative or Overhead Expenses?(Required)

No

Yes

Amount and Percentage

Is This a One-Time Project or an Ongoing Program?(Required)

One-time project

Ongoing program

If Ongoing, How Will the Program Be Financially Supported in Future Years?

Other Funding

Please identify other organizations, governments, foundations, businesses, or individuals that have been approached for funding.

Other Funding Sources

Funding Source

Amount Requested

Confirmed or Pending

Has the Rick & Marg Jensen Family Foundation Previously Supported Your Organization?(Required)

No

Yes

If Yes, Please Provide the Year, Amount, and Purpose of the Previous Grant

Supporting Documents

Please attach the following documents where applicable.

Please Indicate Which of the Following Documents You Are Attaching

Program or project budget

Most recent organizational financial statements

List of current directors or board members

Most recent annual report

Evidence of confirmed funding from other sources

Other relevant supporting information

Upload Supporting Documents

Drop files here or

Accepted file types: pdf, doc, docx, xls, xlsx, jpg, jpeg, png, Max. file size: 10 MB, Max. files: 10.

You may upload multiple files (PDF, Word, Excel, or image files, max 10MB each).

Provide Any Other Information That May Assist the Foundation in Evaluating This Request

Declaration and Authorization

I certify that the information contained in this application is accurate and complete to the best of my knowledge. I am authorized to submit this request on behalf of the organization.

I confirm that any funding received will be used for the charitable or community-benefit purposes described in this application. I understand that the Foundation or Aqueduct Foundation may request additional information, and that submitting an application does not guarantee funding.

If funding is approved, the organization may be asked to provide a brief report describing how the funds were used, the results achieved, and any significant changes to the program or project.

Authorized Representative's Name(Required)

Title or Position(Required)

Signature (Type Your Full Legal Name)(Required)

By typing your name above, you are electronically signing this application.

Date(Required)

Information provided in this application will be used only to evaluate and administer the grant request and to meet applicable administrative and legal requirements.

	1326 Southview Drive, Cranbrook BC V1C 6R1
	250-426-9727
	[email protected]