IOLTA Grant Application | Nevada Bar Foundation

ORGANIZATION INFORMATION

Organization Name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Name*

First Last

Executive Director or Officer

Email Address*

Phone Number*

Is this the primary contact for the grant request?*

Yes
No

Grant Contact

First Last

Grant Contact Email

Grant Contact Phone Number

Organization Website

Year Organization Incorporated*

Federal Tax ID Number*

Attestation*

Select All
The organization is a 501(c)(3) public charity.
The organization is not a 501(c)(3) private foundation.
The organization is not a 509(a)(3) supporting organization.

Number of full-time employees*

Number of part-time employees*

In 500 words or less, please describe the purpose of the organization and its overall programs and services.*

This section is intended to provide the Foundation with a high-level overview of the legal services provided by your organization. The summary should provide information about the assessed need for the program, and how the program will be implemented. In particular, the summary should provide well-defined and measurable objectives for the program or services. In addition, are there any other organizations that provide similar services to the same clients in your areas?

Organization Budget

Current Year Revenue*

Current Year Expenses*

Next Year Projected Revenue*

Next Year Projected Expenses*

GRANT APPLICATION

Attestation: I have read the Selection Criteria and Excluded Use of Funds Notice and attest that this application meets these requirements.*

Yes

The Selection Criteria and Excluded Use of Funds are listed at the top of this webpage.

Program Title*

Please provide a title for the program or services for which you seek funding.

Amount Requested*

In 300 words or less, please provide a summary of the services your organization intends to provide with the requested grant dollars for this program.*

This section is intended to provide the Foundation with a high-level overview of the legal services provided by your organization. The summary should provide information about the assessed need for the program, and how the program will be implemented. In particular, the summary should provide well-defined and measurable objectives for the program or services. In addition, are there any other organizations that provide similar services to the same clients in your areas?

Is funding sought for: (check all that apply)*

Program expenses
Attorney/staff salaries
Operational expenses (ex: facility management, rent, etc.)
Other

Note, follow up questions specific to each checked category will follow.

Program Expenses

Of the total amount requested, how much is sought for program expenses?

In 150 words or less, please provide an overview of the program, including what the program does, who is served, and how the organization would measure success.

Please provide a program budget.

In this section, the organization should provide specified details of where any awarded dollars will be used. (Ex: Marketing: $XX, Supplies: $XX, Travel Expenses: $XX, Training Expenses: $XX). If preferred, you may upload the completed Excel spreadsheet in lieu of entering budget information here.

In 150 words or less, please explain how you market the program to your prospective client(s).

Attorney/Staff Salaries

Of the total amount requested, how much is sought for salaries?

In 150 words or less, please indicate which position(s) the organization seeks to fund and how those positions support a particular program.

Please provide a breakdown of how much of the requested grant funds will be used for each position.

(Ex: 1 attorney position: $XX, 2 paralegal positions: $XX, 1 intake specialist: $XX) If preferred, you may upload the completed Excel spreadsheet in lieu of entering budget information here.

Operational Expenses

Of the total amount requested, how much is sought for operational expenses?

In 150 words or less, please indicate how the ogranization intends to use the funds to support operational expenses.

Please provide a breakdown of how the organization intends to use the funds to support operational expenses. Please include an explanation for any recent increases in cost.

(Ex: monthly rent: $XX, equipment: $XX, anticipated repairs: $XX). If preferred, you may upload the completed Excel spreadsheet in lieu of entering budget information here.

Other Expenses

Of the total amount requested, how much is sought for other expenses?

In 150 words or less, please provide an overview of how requested funds will be used, specifically as they relate to the organization's programs or services.

Please provide a specific dollar breakdown of how the organization intends to use requested funds.

If preferred, you may upload the completed Excel spreadsheet in lieu of entering budget information here.

When will these funds be needed/used? (150 words or less)

Additional Information

In which geographic service area(s) will requested funding be used? Check all that apply.*

In 300 words or less, please tell us how your organization works with other legal aid organizations or other community organizations to fulfill its mission and goals.*

Please provide any additional information your organization would like to share with the Foundation to assist us in our decision making.

Are there other funding sources being sought for this program by the organization or other funding received? Please list source(s) with dollar amount requested or received.*

Did your organization receive funding from the Nevada Bar Foundation for this program last year?*

Yes, IOLTA Grant
Yes, Foundation Grant
No

Previous year IOLTA grant award

In 150 words or less, please provide details including a brief description of what was funded with IOLTA grant dollars and whether measurable objectives for the program or services were achieved.

Previous year Foundation grant award

In 150 words or less, please provide details including a brief description of what was funded with Foundation grant dollars and whether measurable objectives for the program or services were achieved.

Has your organization ever received funding from the Foundation?

Yes
No

Please identify previous grant dollars received and when granted.

AGREEMENT FOR USE OF FUNDS

The undersigned, on behalf of the organization, consents to:

Please check all*

Name

First Last

ADDENDUM

Please upload PDF copies of the following documents.

Previous Fiscal Year Form 990 Tax Return (PDF)*

Drop files here or

If applying for an IOLTA grant for the first time, please submit tax returns for the previous three years.

IRS Non-Profit Determination Letter (PDF)*

Organization Board of Directors List (PDF)*

The list should include the names, phone numbers, and email addresses.

Excel Budget

Drop files here or

In lieu of providing budget details relating to program expenses, salaries, operational expenses and other expenses, you may attach the provided Excel worksheet here.