| Questions? |
Call or email:
Barbara F. Smith (518) 285-4545 |
| Applicant Name: |
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| Federal ID: |
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| Contact Person: |
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| Address: |
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| County: |
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| Judicial District: |
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| Telephone: |
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| Fax: |
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| Email Address: |
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| Grant Request Amount: |
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Total funding necessary
to complete
the project: |
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| Project is: |
New
OnGoing |
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| DESCRIBE YOUR REQUEST: |
- What
problem need or issue does your project address? How
will the project address the problem? Is the project
new or ongoing?
- Who
will be involved in carrying out the project?
- What
persons or groups will be served [including specifics
about demographics such as gender, age]? What geographic
area will
be served by the project?
- If
the project is being conducted in cooperation with other
entities, identify them, their role, contact persons
including address, telephone and fax.
- What
is the anticipated time for project completion? How will
you evaluate the success of the project?
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| FUNDING: |
- If additional funding to
support your project is necessary, provide a list other
funding sources for the request, including amounts and whether
received,
committed or pending.
- If the project has been in operation,
please indicate sources of funding for the past 2 years.
- If
the project will continue beyond this year, please describe
the funding plan and source to sustain its operation.
- Explain
what expenses will be paid from the grant, e.g., staff
salary, direct providers of services, transportation expenses,
equipment,
supplies, printing and copying, telephone and fax, and/or
postage and delivery.
LAT funds may not be used for
general overhead expenses such as rent, utilities or maintenance.
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Is organization an
IRC 501[c][3] Organization: |
If No, Please explain:
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| Name of Executive Director: |
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| Name of Project Director: |
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| For organization, please specify
the number of: |
| Full Time Employees: |
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| Part Time Employees: |
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| Volunteers: |
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| Planned staffing,
volunteers for the project: |
| Full Time Employees: |
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| Part Time Employees: |
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| Volunteers: |
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| What percentages
of operating revenue are derived from: |
| Government Funding: |
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| Grants: |
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| FundRaising: |
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| Investment Income: |
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| Membership Dues: |
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| Other : |
if Other, Please explain:
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Please
note: In addition to the online application, you must
send two copies of the following documents to the Trust:
- a brief description of your organization
- its history and major accomplishments
- a list of the board of directors, describe how it
is selected, by whom and how often
- an organizational chart
- the most recent, completed full year organizational
financial statement
(expenses, revenue and balance sheet), audited, if available
- your organization’s current annual operating
budget
- a description of your bidding procedures, if applicable
- a copy of your IRC 501[c][3] letter
- a statement indicating that you have timely filed
with the Attorney General's Charities Bureau
all required periodic or annual written reports.
Send the attachments to:
Lawyer Assistance Trust
54 State Street, Suite 802
Albany,
NY 12207 |
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