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Grant Request Application

2. Spearfish City Grant Request
   Please complete the following form and upload the required documents to be considered for following Fiscal Year City Grant monies. Grant requests are due by June 12, 2020.

   Please complete the following form and upload the required documents to be considered for following Fiscal Year City Grant monies. Grant requests are due by June 12, 2020.

4. Organization*

5. Name of Contact Person*

7. Street Address*

8. City, State, Zip Code*

10. Email Address*

11. Phone Number*

13. Grant Request Application
    If awarded the funding by the City of Spearfish, the organization agrees to allow access to the financial records and other records that the City may request to review to ascertain that the funds provided by the city are used for the purposes now being requested. If awarded funds for Fiscal Year 2021, I agree the organization will use the funds for the purposes now being proposed and I agree not to use the funds for other purposes without the prior approval of the City of Spearfish. I certify that the information herein provided is accurate to the best of my knowledge.

    If awarded the funding by the City of Spearfish, the organization agrees to allow access to the financial records and other records that the City may request to review to ascertain that the funds provided by the city are used for the purposes now being requested. If awarded funds for Fiscal Year 2021, I agree the organization will use the funds for the purposes now being proposed and I agree not to use the funds for other purposes without the prior approval of the City of Spearfish. I certify that the information herein provided is accurate to the best of my knowledge.

15. Amount Requested*

16. In-kind service request

18. Name of Person Completing Application*

19. Title of Person Completing Application*

21. Signature*

    By typing your name into the field available you are hereby authorizing Spearfish, South Dakota to accept this as your electronic signature.

22. Date*

24. 1. Financial Summary
    Please upload the most recent audited financial statement and organizational budget to include the following: Total Revenues (identifying revenue sources; Total Expenditures (with salaries and benefits, and a breakdown between operations and administration); Other Operating Expenditures; Capital Outlay Expenditures: Estimated Net Surplus (Deficit); Balance Sheet

    Please upload the most recent audited financial statement and organizational budget to include the following: Total Revenues (identifying revenue sources; Total Expenditures (with salaries and benefits, and a breakdown between operations and administration); Other Operating Expenditures; Capital Outlay Expenditures: Estimated Net Surplus (Deficit); Balance Sheet

26. 1a. Financial Summary Attachments*

27. 1b. Financial Summary Attachments

    Upload additional financial documentation if needed

28. 1c. Financial Summary Attachments

    Upload additional financial documentation if needed

30. 2. Additional Attachments
    Please upload any additional attachments in concise form along with another other information you would like considered. Examples: Mission / Vision Statement; Goals for upcoming year(s); Accomplishments in the past 3 years

    Please upload any additional attachments in concise form along with another other information you would like considered. Examples: Mission / Vision Statement; Goals for upcoming year(s); Accomplishments in the past 3 years

32. 2a. Additional Attachments

33. 2b. Additional Attachments

34. 2c. Additional Attachments

35. 2d. Additional Attachments

37. 3. Program Description*

39. 4. Use of Funds*

41. 5. Uniqueness of Service*

43. 6. Contribution to the Citizens of Spearfish*

45. 7. Coverage Area*

    If your organization serves a "regional area", please provide an analysis of revenue sources from all governmental agencies versus citizenship location of persons benefiting from services provided.

47. 8. Number of Persons Benefiting from Funds*

    Please include the total number served and the total number of Spearfish residents served.

49. 9. Name of Person or Agency having Custody of Funds*

51. 9a. Email Address of Person

    If email is different than as listed above.

52. 9b. Phone Number

    If phone number is different than as listed above.

Leave This Blank:


54. 1. Receive an email copy of this form.
55. Email address

    This field is not part of the form submission.

56. Submit

* indicates a required field