Application for a Community K
Grant
Eligibility:
Community K Grants are awarded
to organizations that contribute directly, or indirectly, to the quality
of life of persons living with a spinal cord disability or their
immediate family or caregiver(s). The Kevin Kitchnefsky
Foundation for Spinal Cord Research does not award cash grants. When a
Community K Grant is awarded, the Foundation pays the monies directly to
the organization or individual providing the product and/or service that you
are requesting. Your application must be accompanied by three written
estimates, submitted by three different firms (if applicable), that include an estimate,
terms of payment, an outline of work/product that will be provided and a
projected date of completion/delivery.
Goal: To substantially improve the quality of life for those people
served. Instructions:
Print and fill out this application completely. Use additional paper for
the essays, then attach them to the application and mail to:
Kevin Kitchnefsky
The Kevin Kitchnefsky
Foundation for Spinal Cord Research
109 German Hill Road
Tunkhannock, PA 18640
Privacy:
Please note that your information will be kept private and not sold or
shared with any other organization. You may, from time to time, be
contacted by The Kevin Kitchnefsky
Foundation for Spinal Cord Research regarding events, volunteer
opportunities and other Foundation activities.
Questions may be directed to Kevin or Yvonne at (570) 836-1240.
Step One: Submit your Application for review.
Step Two: We will contact you to set up a personal interview with
a designated liaison.
Step Three: Our Board of Directors will review your application
and the report from our liaison's personal visit with you.
Step Four: Our Board of Directors will select the recipients. All
decisions are final.
Required Information:
Please attach a brief description of your organization and its
goals.
Name of
Organization_________________________________________________________
Date Established_____________________ Tax ID
#________________________________
Geographic Area
Served______________________________________________________
Mailing
Address______________________________________________________________
City_______________________________ State______________
Zip_________________
Telephone_____________________________
Fax________________________________
Email_____________________________
Website_________________________________ Contact
Person_____________________________________________________________
Contact Title___________________________________________
Contact Telephone______________________ Contact
Fax_________________________
Contact Email_____________________________
Amount Requested: $_____________
(use the estimates to decide on an amount)
Is this request time-sensitive? (circle one) YES
NO
If so,
explain________________________________________________________________
__________________________________________________________________________
Essay Section:
Why are you requesting funding? Please attach a brief outline of your
planned use of funds, projected outcome and time frame.
Financial Section:
Please attach a copy of your most financial statement.
Thank you for your interest in
receiving a K Grant!
Signature of person filling
out this request_____________________________
Date_____________
|