Organizational Information Organization Name Address Website URL Employer Identification Number (EIN) Management Governance-Please provide a list of Board Members/Trustees and Officers Staff Members Paid Full TimePaid Part TimeVolunteer Affiliated with National/Regional Organization? YesNo If YES, please provide Name, Address and Web Site URL
Organizational Purpose Organization Vision and Mission: Brief Explanation of Primary Services (Up to 4) and Service Area of your Organization: Population Profile – Brief description of those directly benefitting from your Organization:
Project Information Provide a brief summary of Project for which this grant is requesting funds:
Project Details: Bulletized explanations of the following:
Why the project is needed: What the project entails: Profile of those that will benefit: Project goals: Total amount your organization is requesting from Roman Open Charities: Impact if not fully funded/partially funded: Alternative Funding:
Contact Information Name: Tite/Position: Phone Number: Email: Mailing Address: