BLACK UNITED FUND OF OREGON

Online Proposal

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Important Notes
* Please print for your records.
* The online proposal cover sheet is for database purposes only.
* Please submit the appropriate materials listed at the end of this form.
* Answer each of the questions in the space provided.
* Grant proposals will not be considered if the questions and information requested aren't completed.
* Please do not reference other material.

Instructions
* Applicant must fill out and submit the form in one sitting; therefore please review the form before it's filled out.
* Please click on SUBMIT at the bottom of the page after completing the online cover sheet.
* The online proposal cover sheet cannot be saved.

General Information

Select One

Portland Metro (Multnomah County)
SW Washington
Statewide

Funding Cycle

Organization
(limit to 15 words)

Address

City

State

County

Zip Code

Website

Contact Person

Contact Phone
(exp. 503-777-2193)

Contact Email Address

Executive Director

Executive Director Phone
(exp. 503-777-2193)

Executive Director Email

Have you applied to the Black United Fund of Oregon for funding in the last five years?

Yes
No

(If No, continue to next section)

If yes, what year and cycle?
(exp. 99 Fall, 00 Spring)

Amount of Grant(s) Awarded $
(exp. 2000, 4000)

Have you submitted a project evaluation form for the last grant received?

N/A
Yes
No

Note: It is the policy of the Black United Fund that organizations with overdue evaluations are not eligible for funding.

Organization Information

Employee ID Number (EIN)

Organization Mission Statement
(limit to 100 words)

Brief Description of Organization
(limit to 100 words)

Based on your most recently completed fiscal year, state the percentage of total revenue applied to:

Programs & Services, Administration & Fundraising %
(exp. Admin 10, Fundraising 10, Programs & Services 80)

Programs & Services % Administration %
Fundraising %

If more than 25% of your organization's budget goes toward administration and fundraising, please explain.
(limit to 150 words)

Is your organization registered with the Office of the Attorney General in accordance with relevant provisions of ORS 128.610 to 128.995?

Yes
No

Does your organization receive funding from United Way?

Yes
No

If yes, please explain below how the B.U.F. grant will be applied outside of the scope of your organization's United Way funding.
(limit to 150 words)

Project Information

Programmatic area to which you are applying

Amount Requested
(Use 5000 format numbers only, please)
(limit to 10 characters)

Total project cost
(Use 5000 format numbers only, please)
(limit to 10 characters)

Project start date

Month Day Year

Project end date

Month Day Year

Brief Description of Project
(limit to 150 words)

Specific Use of the Black United Fund's Grant
(limit to 300 words)

What percentage will be applied to:

Programs & Services: %
Administrative & Fundraising: %

County(ies) served:
(limit to 20 words)

Neighborhood(s) served by project:
(limit to 20 words)

Client group to be served by project this year
(limit to 50 words)

Number of clients served by project this year
(use 5000 format numbers only, please)
(limit to 10 characters)

Number of clients served by project last year
(use 5000 format numbers only, please)
(limit to 10 characters)

CURRENT ORGANIZATIONAL STATISTICS

(Please provide as much tracking information as you can)

Income

Do not track

Less than 50% of area median income*

Between 50% - 80% of area median income*

Between 80% - 100% of area median income*

More than 100% of area median income*

Total (try to ensure that total equals 100%)

*See City of Portland Bureau of Housing and Community Development Median Income Chart on the Grant Seekers Page. If applying from a different city please base your information on the Median Family Income in your area.

Ethnicity

Do not track

American-Indian or Alaskan Native

Asian or Pacific Islander

Hispanic

White, not of Hispanic origin

Black, not of Hispanic origin

Other (specify) :

Total (try to ensure that total equals 100%)

Gender

Do not track

Female population>

Male population

Total (try to ensure that total equals 100%)

List all income (specific amount) and sources committed to this project

List pending funding sources applied to the project and amount of request

Please detail your organization's efforts to move toward self-sufficiency and sustainability
(limit to 300 words)

Please check the application materials you will submit with your full application (see below):

Please list the item numbers in the top right corner of the corresponding document

1. Proposal Narrative (See Guidelines)	Yes No
2. Organizational Budget immediately preceding fiscal year's financial statement	Yes No
3. Project Budget	Yes No
4. Organizational Diversity Chart	Yes No
5. Most recent year's audit or accountant reviewed financial statements depending on your budget size (see guidelines)	Yes No
6. Organization's financial statements (IRS form 990) for last completed fiscal year	Yes No
7. Board of Directors Roster	Yes No
8. IRS 501©3 tax-exempt notification letter	Yes No
9. Copy of CT12	Yes No
10. Policy of non-discrimination	Yes No
11. Anti-terrorism policy.	Yes No

Double check your responses and then click the "Submit" button to file your cover sheet with BUFOR.

Proposal Application Packet

Please send the complete proposal application packet to the Black United Fund's office after submitting your online cover sheet. Incomplete proposal application packets are not eligible for consideration.

Grant Allocations Committee
Black United Fund of Oregon, Inc.
2828 N.E. Alberta St.
Portland, OR 97211

Please see application guidelines for the appropriate number of copies.

Complete application packets contain the SUPPORT MATERIALS listed below.

If you have any questions, please contact the Black United Fund of Oregon's office at 503-282-7973.

Please include THREE copies of the following:

Proposal cover sheet (Copy of online submitted cover sheet)
Proposal Narrative
Board of Directors Roster
Organizational Diversity Chart
Organizational Budget (Revenues/Expenses)
Project Budget (if applying for a project)
Any additional support documents
Organization's most recent audited report or accountant reviewed financial statements depending on your budget size (see guidelines)
Organization's IRS form 990 for last completed fiscal year.

Please include ONE copy of the following:

Copy of the organization's IRS 501© 3 Letter. NOTE: If applicant is using a fiscal sponsor, please send the fiscal sponsor's IRS tax exempt letter and signed statement from Executive Director and Board Chair agreeing to be fiscal sponsor for the grant as well as the fiscal agents. Also, submit either their IRS 990 Form or annual report. An organization may act as fiscal sponsor for one organization only and their budgets must be $600,000 or less.
Organization’s CT-12
Copy of non-discrimination policy
Anti-terrorism statement

Policy and Statement Suggested Language:

Copy of the organization's non-discrimination policy. NOTE: The policy must apply to staff, program services and membership on the governing board, and must cover all the classes protected under applicable local, state or federal law including the race, color, creed, religion, sex, age, national origin, marital status, gender, identity, disability, source of income, veteran status or any other characteristic protected under the law.
Anti-terrorism statement: We certify that we do not knowingly employ people or support groups whose names appear on terrorist watch lists compiled by the government.