IOLTA Grant Application | Nevada Bar Foundation

Organization Geographic Service Area: please check all that apply.

*

Carson City
Churchill County
Clark County
Douglas County
Elko County
Esmeralda County
Eureka County
Humboldt County
Lander County
Lincoln County
Lyon County
Mineral County
Nye County
Pershing County
Storey County
Washoe County
White Pine County

Please briefly describe your organization’s overall programs and services.*

Number of People Organization Serves

Number of people served in 2021*

Is this number actual or an estimate?*

Number of people served in 2022*

Is this number actual or an estimate?*

Number of Direct Service Cases Organization Provides

Number of direct service cases provided in 2022*

Is this number actual or an estimate?*

Number of direct service cases provided in 2022*

Is this number actual or an estimate?*

PROGRAM DESCRIPTION

Program Title*

Amount Requested*

Program contact*

Email*

Phone*

Please provide a brief description of the program for which you seek funding.*

Please include the program goals and objectives, as well as the activities conducted to achieve them. (Please limit to 500 words)

Has the NBF previously granted funding for this program?*

Yes
No

Please describe your previously granted funding for this program*

If this is a new program, will it continue after all NBF grant funds are expended?*

Yes
No
N/A

If this is a continuation or expansion of an existing program, how long has the program existed?

4. Please identify how many of the following people this program will serve.

Will the program serve children?*
Yes
No

Number of Infants

Number of Pre-K Children

Number of School Age Children

Number of College Students

SUBTOTAL: Number of Children

Will the program serve adults?*
Yes
No

Number of Domestic Violence Victims

Number of Veterans

Number of Disabled

Number of Elderly

Number of Other Adults Served

SUBTOTAL: Number of Adults

TOTAL NUMBER OF PEOPLE SERVED

Please check the geographic service area(s) the program for which you seek funding will serve.*
Carson City
Churchill County
Clark County
Douglas County
Elko County
Esmeralda County
Eureka County
Humboldt County
Lander County
Lincoln County
Lyon County
Mineral County
Nye County
Pershing County
Storey County
Washoe County
White Pine County

Using IOLTA grant dollars, will your organization provide legal services in geographical areas serviced by other legal aid organizations?*
Yes
No

Please describe any potential overlap in service delivery with other legal aid organizations in your geographic area and what efforts, if any, your organization takes to avoid duplication of services.*

Please describe how your organization will staff this project.*

Is your organization considered to be a legal services organization?*
Yes
No

PROJECT FUNDING

What is the average cost per person served under this grant?*

Based on the amount requested and the average cost per person, how may clients would be affected if available funding cannot be provided at the requested amount?*
For example, please illustrate the reduction in services per person if available funding was provided at 15%, 25% or 50% below the requested amount.

Please list all previous expenditures for this program.*

If the NBF cannot fund this program in whole, does support exist, either in hand or prospective, from other sources?*
Yes
No

If yes, please indicate the amount of funding available, or funding sought, and the sources for that funding.

If the Nevada Bar Foundation does not award this grant, how will the program be funded?*

If the Nevada Bar Foundation does award this grant, how will the organization continue the program beyond this funding cycle? Who will provide funding?*

This application represents what percentage of the total budget of the:

Organization:*
Please enter a value between 1 and 100.

Program:*
Please enter a value between 1 and 100.

Does this program receive funding from other organizations/sources?*
Yes
No

PROJECT BUDGET FORM

Organizational Fiscal Year Beginning:*

Organizational Fiscal Year Ending:*

EXPENSES (Please list expenditures required to administer this program.)

Professional Staff Costs:*

Support Staff Costs:*

Other Staff Costs:*

Subtotal for Personnel Costs:*

Total Non-Personnel Costs:*

Administrative Personnel Costs:*

Administrative Non-Personnel Costs:*

Total Administrative Costs:*

Total Expenditure*

AGREEMENT FOR USE OF FUNDS

Grant Cycle Year: 2021

Organization Name

The undersigned, on behalf of the organization consents to: (please check all)*
Utilize the funds granted to this organization by the Nevada Bar Foundation for the current grant cycle solely for the purpose permitted and outlined in the application.
Agree to repay the Nevada Bar Foundation any amount not used for the purposes of this grant.
Open its financial records for review upon request of the Nevada Bar Foundation, limited to the previous two years.
Not utilize the funds granted to it by the Nevada Bar Foundation for any purposes other than permitted by Nevada Supreme Court Rules 216 through 221 and as further permitted by the Internal Revenue Code Section 501 (c)(3) of the United States Internal Revenue Services.
Release its application and subsequent reports as property of the Nevada Bar Foundation for use of any or all information presented, whether or not the application is accepted for funding.
Appropriate credit or recognition to the Nevada Bar Foundation in any printed or electronic materials and communications describing activities which are wholly or partially funded by grant funds.
Submit a revised budget if the amount awarded is less than the original requested amount.
Submit a final report, on a form provided by the Nevada Bar Foundation, no later than January 16, 2023.
Furthermore, this organization acknowledges that failure to timely submit final report may result in a loss of funds in future years.

Program Director's Signature*
Please type full name

Date*

Board Chair's Signature*
Please type full name.

Date*

GRANT APPLICATION ADDENDUM

A list of the organization’s Board of Directors, including name, phone number and email address.*

Drop files here or

A copy of the organization’s Form 990 tax returns for the past three years.*

Drop files here or

A copy of the organization’s IRS determination letter. If not a tax exempt organization, please attach an explanation of the IRS status.*

Drop files here or