ARIZONA DISABLED VETERAN FOUNDATION

P. O. Box 39487
Phoenix, Arizona 85069
623-330-8215
GRANT APPLICATION
Name of Organization__________________________________________________EIN # _________________

Address of Organization______________________________________________________________________

City_________________________________________State____Arizona__________Zip Code_____________

Telephone Number__________________________ Fax Number _____________________________________

Name and Title of Individual preparing grant application. ___________________________________________

Is your organization a Department, State Headquarters, Chapter, Post or Other?_________________________

PLEASE PROVIDE THE PURPOSE FOR WHICH THE GRANT IS BEING REQUESTED?
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Amount of grant funding you are requesting? ____________________________________________________

Describe how the grant will be used and how it will aid or assist (disabled or non-disabled) veterans.
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If your intent is to purchase equipment, materials or supplies, please describe how you feel this would benefit
the veterans you serve.
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Does your organization have a Veteran’s Service Officer? ___________________________________________

If yes, does your Service Officer work from home or at the organization’s address? _______________________

Provide Name, Address and Phone Number ______________________________________________________

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If the Service Officer will not be the only individual deciding on how to use grant funds, who else in the
organization will be making those decisions? (Name(s) and Title(s)
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Does your organization have a Treasurer or Accountant? _____Yes ______No

If Yes, Name and Phone Number ______________________________________________________________

If yes, will this person be primarily responsible for the handling and administering of grant funds? __________

If no, who will be primarily responsible for handling and administering of grant funds? (Name and Title)
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Does your organization work on a fiscal year basis or calendar year basis? If fiscal, please provide us with your
fiscal year__________________________________________________________________________________

Does your organization require you to have an audit performed on your accounting records each year?______

Do you have an independent CPA or auditing firm? ________________________________________________

If yes, Name, Address and Phone Number of your Auditor

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Who are your required to submit a copy of your audit too? _____State Headquarters, ______National
Headquarters, ______Other, specify___________________________________________________________

Do you file any records with the I.R.S. if so, what documents? _______________________________________

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What are your organization’s source(s) of income at the present?

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Does your organization plan to use some of your own funds with the grant funds you are requesting?________

If yes, from what source and approximately how much? ____________________________________________

The Board of Directors for the Foundation will require proof from time to time that the funds given in the form
of a grant are being used for the purpose(s) intended. Would your organization have any problem with
supplying documentation on how the grant funds are being used? ________ Yes _________No

If requested, would your organization be willing to furnish the Foundation with a Financial Statement or if
available your CPA’s Annual Audit? ________ Yes __________ No

Is there any other information you wish to provide the Foundation which you feel may be of benefit or assist
the Foundation in making its decision on your request for Service Grant Funding? Write below

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Application Date _____________________

Name(s) of Organization Officer(s) making application:

Name ____________________________Title ______________________Signature_______________________

Name ____________________________Title ______________________Signature_______________________

Name ____________________________Title ______________________Signature_______________________

Name ____________________________Title ______________________Signature_______________________

Please be advised the Board of Directors for the Foundation does not meet on a daily basis. Your application
will be given all due consideration and you will be notified as soon as the Board has made a decision on your
grant application.
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NOTES

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Date application received ________________________ Date Considered ______________________________

Voting Members of the Board who considered Application (Initials)

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Votes in favor of approval _____________________ Votes in favor of disapproval _______________________

AMOUNT APPROVED $________________________

Voucher or Check Number _____________________ Date sent ______________________________________

Board Member Signature _____________________________________________________________________

Board Member Signature _____________________________________________________________________

Board Member Signature _____________________________________________________________________