City of Daytona Beach

Application for Donation/Grants

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Fiscal Year

Application Submittal Date

The City of Daytona Beach is committed to enhancing quality while perfecting customer service, and establishing Daytona Beach as the preferred place to live, work, play, learn and raise a family.

Agency or Organization Name:

Location:

Telephone Number:

Mailing Address:

Contact Name:

Contact Title:

Contact Phone Number:

Email Address

Would you like to add another contact?

Yes

No

Secondary Contact Name: Optional.

Secondary Contact Title: Optional.

Secondary Contact Phone Number: Optional.

Secondary Email Address: Optional.

Month and Year Agency/Organization was created:

Agency/Organization's Non-Profit Number Registered with the Florida Secretary of State: Provide a Copy.

Please Provide a Copy of Your Agency/Organizations Non-Profit Number Registered with the Florida Secretary of State:

Agency/Organization's IRS Non-Profit Number: Provide a Copy.

Please Provide a Copy of Your Agency/Organizations IRS Non-Profit Number:

What Other Agencies is Your Organization Affiliated With?

Please Indicate Which of the Following Categories You Believe Your Agency/Organization's Function Would Best Fall Within: Select All That Apply. Values are not selected

Description of Agency/Organization Program

Start Date for When Funding is to be Used for Program:

Completion Date for When Funding is to be Used for Program:

Amount Requested for This Program From the City:

1. Agency/Organization description, mission statement, and local history.

2. Whom does your organization serve? If you have a membership, please provide number. Please give an estimation of City residents involved in your organization.

3. Specifically, how will donation/grant funds be utilized?

4. What will the donation/grant funds help your agency/organization accomplish? Please list the anticipated outcomes grant money will influence.

5. What other agencies/organizations fund your activities? (Express in $'s and %'s)

6. How will the community benefit from the use of public funds to asist your agency/organization? (Please describe the benefit to the community/public purpose)

7. In what jurisdiction/location do you plan to use the grant money?

8. If the grant is awarded, how do you plan to promote the opportunity affiliated with grant money?

Please attach a copy of the most recent adopted budget of your agency/organization; a copy of the agency/organization by-laws, a list of the agency Board Members and a copy of the non-profit state and federal ID numbers.

By submitting this form, you agree all information provided on this application (or required documents) is correct, accurate and complete to the best of my knowledge.

Typed Name of Applicant

Title of Applicant

Date of Application

Should you receive a City of Daytona Beach grant, the following will be required: Sponsorship statement and City logo on promotional pieces the grant money affects, which must be approved by the Communicaton Department with the City of Daytona Beach. Electronic photographs, when possible, of the grant investment in use. Follow-up report with a description of ways the funds were spent, grant impact such as the number of people served, an overview of how the public money affected the services of your organization, and copies of promotional materials.

Please contact Office Manager Bobbie Yarbrough with any questions regarding this application at GrantApplications@codb.us or call (386) 671-8009.

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Application for Donation/Grants

City of Daytona Beach

Description of Agency/Organization Program