Community Partnership Application

For more information, please get in touch with us at mayor@goshencity.com or call 574-533-9322 with questions.

"*" indicates required fields

Date*

Organization*

Address

Street Address Address Line 2 City State ZIP Code

Contact Person*

First Last

Email*

Project Title*

Amount Requested*

Website

Additional Organizational Information*

Briefly describe your organization’s structure and services provided.

Additional Organizational Information Continued*

Organizational mission statement and vision statement:

Years in operation

Number of full-time paid staff

Number of volunteers

List of Board Members

II. Previous Year Summary of Activities. If you received Community Partnership funds in a prior year, please answer the questions in this section.

Describe how the funds were utilized

(250 words or less)

How was the City recognized as a Partner?

In your previous project, how was the City recognized as a Partner in your project/event?

III. Proposed Project Description

Proposed Project Description

(250 words or less)

Community needs or problems to be addressed

Population or area to be served

Population (or area) to be served. Who will benefit from this project or program? Include demographic information in this description (age, income, ethnicity, race, etc.)

Person(s) responsible to complete the work

Project timeline

Start Date

End Date

Goals:

What are the measurable goals for this project? How will you define and measure success?

What date do you anticipate need these funds?

Describe how grant funds will be utilized

To be considered, your proposed project must meet one of the following priorities:
Comprehensive Plan Goal
CDBG Five-Year Consolidated Plan Goal
Other: Urgent community development needs

How will the project meet one of more objectives

In 250 words or less, describe how the project will meet one or more objectives identified in the Goshen Comprehensive Plan, CDBG Consolidation Plan, or meet an urgent community development needs.

To partner with the City of Goshen, you must have Liability Insurance and provide the City of Goshen with a Certificate of Liability Insurance naming the City as an additional insured.

Please confirm that you can provide this information by checking this box.

Yes. We have Liability Insurance and can provide a Certificate of Liability naming the City of Goshen as an additional insured on our policy.

Attachment Checklist:

Previous Year Financial Statement
List of Previous Year Sponsors
2-4 Previous Year Photos (.jpg preferred)
Current Project Budget
Current Fiscal Year Budget
IRS 501c3 Designation Letter (optional)
Certificate of Liability Insurance (optional – only required approval of grant request)

Upload previous year financial statement for your organization (PDF)

Max. file size: 64 MB.

Upload list of previous years sponsors (PDF)

Max. file size: 64 MB.

Upload 2-4 previous year photos (.jpg preferred)

Drop files here or

Max. file size: 64 MB.

Upload current fiscal year budget for your organization

Max. file size: 64 MB.

Upload IRS 501c3 designation letter (optional)

Max. file size: 64 MB.

Upload Certificate of Liability Insurance naming the City of Goshen as an additional insured

Max. file size: 64 MB.

Applicant Signature*

Date

Phone

This field is for validation purposes and should be left unchanged.