Charitable Foundation Grant Application

By completing this application you certify you are an authorized representative of the organization listed above with authority to apply for grants and other financial support. Further, you understand that any funds that may be awarded as a result of this grant application are expected to be used for the specific purpose for which the funds are requested, as stated in this grant application.

If your files are too large to upload please email your documents to marketing@jcsbank.com.

Legal Name of Organization

Street Address

City

State/Region

Postal Code

Organization Website

Organization Phone Number

Chief Executive Officer (CEO)/Executive Director

CEO/Executive Director Email

CEO/Executive Director Phone

Name of person completing if different than above.

Contact Email

Contact Phone Number

Please list the principal purposes and services of your organization.

Tell us the specific purpose for which funds are requested.

Upload cover letter (required)

Is this a new program?

Yes No

Amount Requested (up to $5,000)

Project Budget (if applicable)

Period of time in which funds will be spent

Organization's Total Budget

For Fiscal Year

Does your organization receive support from United Way, Combined Health, Arts Council or other federated funds?

Yes No

Does your organization have a letter from IRS stating 501(c)(3) or 170(c)(1) tax status?

Yes No

Upload IRS notice

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Use our information request form, visit any of our offices, or give us a call at 860-376-4444 and find out how Jewett City Savings Bank can help you.

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