Bess Spiva Timmons Foundation
Bess Spiva Timmons Foundation

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Bess Spiva Timmons Foundation
Grant Application Requirements
APPLICATIONS FOR GRANTS MUST BE IN WRITING AND RECEIVED BETWEEN JAN. 1
 AND JULY 1 IN ORDER TO BE CONSIDERED AT THE SELECTION COMMITTEE MEETING.

All applications should be presented to the U. S. Bank, N.A., Private Client Group office at

402 South Main Street (second floor), Joplin, Missouri,

or mailed to U. S. Bank, N.A., Private Client Group at P.O. Box 8, Joplin, MO 64802.

 

Applications will be presented to the Selection Committee for careful evaluation

in accordance with the criteria/guidelines of the Foundation.

 

A copy of the organization’s 501(c)(3) determination letter must be attached to this application,

and the verification affidavit (located at the end of this application) must be executed on

behalf of the organization in order for the application to be considered. 



Summary Checklist

Does this application include:

 

            A copy of the IRS 501(c)(3) designation letter (must attach)?                       Yes     No

 

            Signed 501(c)(3) verification affidavit (page 3)?                                           Yes     No

 

            History/Background of the organization?                                                       Yes     No

 

            Project title/anticipated cost and amount requested?                                     Yes     No

 

            A budget for the project (please attach)?                                                      Yes     No

 

           Timeline for implementation?                                                                         Yes     No

 

           Current financial statement of the organization (please attach)?                   Yes     No

 

           Roster of organization board of directors (please attach)?                            Yes     No

 

            Other attached materials (please list)?                                                           Yes     No

 

 

Note: All applications must be typewritten and may be submitted using page 2 of this form

or as a separate document in the same format as this application.

 

If a separate document is used, please limit the space on the separate document to the

space as allocated on page 2. Items on the checklist, which are not included on page 2,

should be provided as an attachment to the application.



          
INFORMATION ABOUT THE APPLICANT
Name and Address of Organization:                    ____________________________________________
                                                                        ____________________________________________

                                                                        ____________________________________________
                                                                        ____________________________________________ 
Web Site of Organization (if any): _________________________________________________________
Contact Person(s): ___________________________________ Phone Number: ____________________
Contact Person(s) email address: _________________________________________________________
Federal Taxpayer ID Number (E.I.N.): _______________________________________________________
History and Background of Organization (including a brief mission statement): _____________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
_____________________________________________________________________________________. 
 
INFORMATION ABOUT THE REQUEST 
Project Title: ____________________________________________________________________________. 
Total Project Cost: $ _______________.              Request of Timmons Foundation: $ ________________.
Description and Objectives of the Project:____________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________.
Specifically, how will the funds be used?_____________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________.
Time period for implementation: ____________________________________________________________
______________________________________________________________________________________
Client Group to be served by the project (including number)? ____________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________.
Other funding sources for the project: _______________________________________________________
______________________________________________________________________________________.
Please list other attached materials: ________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________.
       
          
SIGNATURE PAGE AND
501(c)(3) VERIFICATION AFFIDAVIT

          
The undersigned, a duly appointed officer of______________________________________
_____________________________________ (hereinafter referred to as the “Organization”), 
hereby certifies that the information contained in this application is accurate, and the 
undersigned is authorized by the governing Board of the Organization to submit this grant 
application to the Bess Spiva Timmons Foundation; that as of the date of this application, the 
Organization is operating as an exempt organization as described in Section 501(c)(3) of the 
Internal Revenue Code of 1986, as amended; that said Organization has provided to the Bess 
Spiva Timmons Foundation a copy of its letter from the Internal Revenue Service informing the 
Organization of the determination of its exempt status; and that the Organization has not, for 
any reason, lost or relinquished its tax exempt status.
Dated this  _________ day of  _______________________, 2______.
 
_____________________________________
(Name of Organization)
By: __________________________________
                                                                                    Signature
 
                                                                        _____________________________________
                                                                                    Name
 
                                                                        _____________________________________
                                                                                    Title
 
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