non_gov_grant

GRANT LETTER OF SUPPORT APPLICATION FORM FOR NON-GOVERNMENTAL ENTITIES ONLY

Miami-Dade Office of the State Attorney Office, 11th Judicial Circuit

1.Who should be contacted with respect to the Letter of Support? (For additional information)

Name: *

Telephone Number: *

Fax Number:

E-mail: *

2. - a. To whom should the Letter of Support be addressed and what is the mailing address? Give name of contact person and address. *

2. - b. What is the deadline to receive the Letter of Support? (Indicate the date needed.)

3. Have we provided your organization with a Letter of Support in the past? If so, for what initiative and, was the grant awarded? (charactor max 500) *

4. How long has your organization been in existence and is it a non-profit or for profit organization? (charactor max 500) *

5. List each of your sources of funding that exceed 25% of your annual budget? (charactor max 2500) *

6. If governed by a Board of Directors, list names of all Board members and positions: (charactor max 500)

7. Who is your Fiscal Agent? Indicate who receives and disburses funds. (charactor max 500) *

8. How is your organization audited and how often? (charactor max 500) *

9. List your current grant awards and sources? For example:,City, County, Federal, Private Foundation (charactor max 1000) *

10. What is the amount of the grant you are applying for and the source? (charactor max 1000) *

11. How is the grant going to serve the community at large? Briefly explain purpose of grant. (charactor max 1000) *

12. List all of the partners that will be part of this grant and their roles. (charactor max 1500) *

13. Have you ever been denied a grant renewal? If yes, list specific details. (charactor max 1000)

14. Will the grant impact the State Attorney's Offices' resources? *

Yes

If yes, will funds be available from this grant to address this impact? (character max 500)*

DRAFT LETTER:

To facilitate your application, please attach below a draft letter of support for our use.

* = Input is required