STCCF Application Siletz Tribal Charitable Contribution Fund Step 1 of 4 25% InstagramThis field is for validation purposes and should be left unchanged.Please read the STCCF Eligibility Requirements before filling out this application. If you would like to save this application and continue it at a later date, please click the "Save Application and Continue Later" button at the bottom of the page at any time. You will be sent a link to the email address provided and have up to 30 days to complete your application.1st Application Check here only if organization is applying for 1st time and has never submitted an STCCF application in the past.Date(Required)Applicant Organization:(Required)Contact Name:(Required)Title:Daytime Phone:(Required)Email Address:(Required) Mailing Address(Required)City(Required)State(Required)Zip(Required)County(Required)BentonClackamasLaneLincolnLinnMarionMultnomahPolkTillamookWashingtonYamhillOut-of-Service AreaCheck eligibility criteria below:Evaluation(s) for past STCCF awards are up-to-date?(Required) Yes No N/A Evaluations must be current and up-to-date. Applicants with past due evaluations are not eligible for new awards. Organization is located within 11-county service area?(Required) Yes No You can find a list of the approved counties on the STCCF Eligibility Requirements page.Organization is a Native American entity located in US?(Required) Yes No If claiming Native American Organization status, explain why you are eligible:(Required)If selected for an STCCF award, check should be made payable to:(Required)Organization has an open, unexpended STCCF award?(Required) Yes No N/A If yes, award #:(Required)Evaluation deadline:(Required)Will funds be expended for awarded purpose by deadline?(Required) Yes No N/A Past awards must be expended within 12 months of receipt. If applicant will have an unexpended balance, please contact STCCF. Will evaluation report be submitted by the deadline?(Required) Yes No N/A If choosing the Save and Continue option, please save a copy of your entries locally on your device in case of any technical errors. Project InformationHow many will benefit from the proposed project?(Required)Proposed start date of project:(Required)Cannot occur prior to distribution of awards for quarter making request.Grant Category(Required) The Arts Drug & Alcohol Treatment Prevention Cultural Activities Environmental & Natural Resources Preservation Housing Historical Preservation Gambling Addiction Public Safety Health Education Other (please describe) Other, describe:(Required)Project Summary(Required)Briefly summarize (in 3-4 sentences) the purpose of your request. Describe the basic project, types of activities, what will be accomplished, where, target participants, and when:Capacity & Program Sustainability(Required) For ongoing programs, describe your organization’s capacity to manage and report on grant funds, complete the project activities, and sustain the program beyond the term of any STCCF funding. For equipment requests, describe the expected lifetime of equipment and ability to provide adequate storage and security. Include any collaborations/partnerships related to capacity and success of organization. Goals & Outcomes Describe 1-3 goals of organization or project demonstrating how the requested STCCF funding will help achieve those goals. Goals are specific, measurable, achievable and realistic with defined time frame. Goal(Required)Strategy(Required)Outcome(Required)GoalStrategyOutcomeGoalStrategyOutcomeOrganization Description(Required)Clearly and concisely describe the mission and structure of your organization. The information may be used for public media releases and announcements of STCCF awards.Project Description(Required) In space provided, concisely and clearly describe the proposed project and activities. Be specific about how any potential STCCF award funding would be used. If choosing the Save and Continue option, please save a copy of your entries locally on your device in case of any technical errors. Proposed Project BudgetA. Total Applicant Share Matching Funds SECURED(Include other funder grants, in-kind volunteer hours, donated materials, project budget)B. Total Applicant Share Matching Funds PROPOSED and pending(may include fundraising, in-kind, donated materials, services, labor, etc.)C. Total Amount REQUESTED from STCCF*(Required)Total cost of the Project (A+B+C = Total Project Budget)Summary of Secured and Proposed Matching Funds*Under Funding Source, do not include amount requested from STCCF.Funding Source OneFunding Source(Required)Secured Funds(Required)Proposed Funds(Required)If proposed, indicate date.(Required)Add Another Funding Source?(Required) Yes No Funding Source TwoFunding Source(Required)Secured Funds(Required)Proposed Funds(Required)If proposed, indicate date.(Required)Add Another Funding Source?(Required) Yes No Funding Source ThreeFunding Source(Required)Secured Funds(Required)Proposed Funds(Required)If proposed, indicate date.(Required)Add Another Funding Source?(Required) Yes No Funding Source FourFunding Source(Required)Secured Funds(Required)Proposed Funds(Required)If proposed, indicate date.(Required)Add Another Funding Source?(Required) Yes No Funding Source FiveFunding Source(Required)Secured Funds(Required)Proposed Funds(Required)If proposed, indicate date.(Required)Add Another Funding Source?(Required) Yes No Funding Source SixFunding Source(Required)Secured Funds(Required)Proposed Funds(Required)If proposed, indicate date.(Required)Add Another Funding Source?(Required) Yes No Funding Source SevenFunding Source(Required)Secured Funds(Required)Proposed Funds(Required)If proposed, indicate date.(Required)Add Another Funding Source?(Required) Yes No Funding Source EightFunding Source(Required)Secured Funds(Required)Proposed Funds(Required)If proposed, indicate date.(Required)Add Another Funding Source?(Required) Yes No Funding Source NineFunding Source(Required)Secured Funds(Required)Proposed Funds(Required)If proposed, indicate date.(Required)Add Another Funding Source?(Required) Yes No Funding Source TenFunding Source(Required)Secured Funds(Required)Proposed Funds(Required)If proposed, indicate date.(Required)TotalsTotal SecuredTotal ProposedTotal CombinedIn no other sources or cash, in-kind, or fundraising is being solicited for this project, please explain why.(Required)Detailed Project Budget The detailed budget must show the amounts to be expended for each line item of the project budget over the term of any STCCF award for each column of amount requested from STCCF and applicant share for Secured and Proposed matching funds. Attach cost estimate/quotes from vendor/contractors for equipment, construction, etc. Totals for rows and columns are auto-calculated from numbers entered. The TOTALS of two rows at bottom of page must match for application to be accepted. Budget Item OneBudget Items(Required)(Include quantities and cost per item)Requested from STCCF(Required)Secured(Required)Applicant ShareProposed(Required)Applicant ShareTOTALSAdd Another Budget Item(Required) Yes No Budget Item TwoBudget Items(Required)(Include quantities and cost per item)Requested from STCCF(Required)Secured(Required)Applicant ShareProposed(Required)Applicant ShareTOTALSAdd Another Budget Item(Required) Yes No Budget Item ThreeBudget Items(Required)(Include quantities and cost per item)Requested from STCCF(Required)Secured(Required)Applicant ShareProposed(Required)Applicant ShareTOTALSAdd Another Budget Item(Required) Yes No Budget Item FourBudget Items(Required)(Include quantities and cost per item)Requested from STCCF(Required)Secured(Required)Applicant ShareProposed(Required)Applicant ShareTOTALSAdd Another Budget Item(Required) Yes No Budget Item FiveBudget Items(Required)(Include quantities and cost per item)Requested from STCCF(Required)Secured(Required)Applicant ShareProposed(Required)Applicant ShareTOTALSAdd Another Budget Item(Required) Yes No Budget Item SixBudget Items(Required)(Include quantities and cost per item)Requested from STCCF(Required)Secured(Required)Applicant ShareProposed(Required)Applicant ShareTOTALSAdd Another Budget Item(Required) Yes No Budget Item SevenBudget Items(Required)(Include quantities and cost per item)Requested from STCCF(Required)Secured(Required)Applicant ShareProposed(Required)Applicant ShareTOTALSAdd Another Budget Item(Required) Yes No Budget Item EightBudget Items(Required)(Include quantities and cost per item)Requested from STCCF(Required)Secured(Required)Applicant ShareProposed(Required)Applicant ShareTOTALSAdd Another Budget Item(Required) Yes No Budget Item NineBudget Items(Required)(Include quantities and cost per item)Requested from STCCF(Required)Secured(Required)Applicant ShareProposed(Required)Applicant ShareTOTALSAdd Another Budget Item(Required) Yes No Budget Item TenBudget Items(Required)(Include quantities and cost per item)Requested from STCCF(Required)Secured(Required)Applicant ShareProposed(Required)Applicant ShareTOTALSAdd Another Budget Item(Required) Yes No Budget Item ElevenBudget Items(Required)(Include quantities and cost per item)Requested from STCCF(Required)Secured(Required)Applicant ShareProposed(Required)Applicant ShareTOTALSAdd Another Budget Item(Required) Yes No Budget Item TwelveBudget Items(Required)(Include quantities and cost per item)Requested from STCCF(Required)Secured(Required)Applicant ShareProposed(Required)Applicant ShareTOTALSAdd Another Budget Item(Required) Yes No Budget Item ThirteenBudget Items(Required)(Include quantities and cost per item)Requested from STCCF(Required)Secured(Required)Applicant ShareProposed(Required)Applicant ShareTOTALSAdd Another Budget Item(Required) Yes No Budget Item FourteenBudget Items(Required)(Include quantities and cost per item)Requested from STCCF(Required)Secured(Required)Applicant ShareProposed(Required)Applicant ShareTOTALSAdd Another Budget Item(Required) Yes No Budget Item FifteenBudget Items(Required)(Include quantities and cost per item)Requested from STCCF(Required)Secured(Required)Applicant ShareProposed(Required)Applicant ShareTOTALSAdd Another Budget Item(Required) Yes No Budget Item SixteenBudget Items(Required)(Include quantities and cost per item)Requested from STCCF(Required)Secured(Required)Applicant ShareProposed(Required)Applicant ShareTOTALSTotalsTotal Requested from STCCFTotal From AboveTotal Secured (Applicant Share)Total From AboveTotal Proposed (Applicant Share)Total From AboveTotal CostTotal From AboveTotal Requested from STCCFTotal From Proposed BudgetTotal Secured (Applicant Share)Total From Proposed BudgetTotal Proposed (Applicant Share)Total From Proposed BudgetTotal CostTotal From Proposed BudgetIF THE 2 ROWS OF TOTALS ABOVE DO NOT MATCH - CHECK ALL ENTRIES ON THIS PAGE. THE 2 ROWS OF TOTALS MUST MATCH FOR APPLICATION TO BE ACCEPTABLE. If choosing the Save and Continue option, please save a copy of your entries locally on your device in case of any technical errors. Certification:By signing the application form, the signer certifies: The information provided is accurate and that any grant funds received will be used according to the stated purpose and any approved awarded purposes only. The organization will comply with all STCCF regulations and guidelines. STCCF funds will expend funding only for the purposes as stated in award notice. The organization will make reasonable efforts to publicly announce receipt of an STCCF award. The organization will provide the required evaluation report by the deadline. The organization will return all unexpended funds by the deadline, unless a written request is submitted and approved in advance of the deadline by the STCCF Advisory Board. The signatory has the authority to commit the organization to these conditions. Applicant's Signature(Required)Date(Required)A copy of this application will be sent to you via the email provided. Please keep this for your records.Upload Document(s)Attach cost estimate/quotes from vendor/contractors for equipment, construction, etc. Drop files here or Select files Accepted file types: png, jpg, jpeg, doc, docx, pdf, Max. file size: 10 MB, Max. files: 5. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. If choosing the Save and Continue option, please save a copy of your entries locally on your device in case of any technical errors.
