Questions? Call or email: Barbara F. Smith (518) 285-4545
Applicant Name:
Contact Person:
Address:
County:
Judicial District:
Telephone:
Fax:
Email Address:
Grant Request Amount:
Total funding necessary
to complete the project:
Project is: New OnGoing
 
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?

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.

Is organization an
IRC 501[c][3] Organization:


If No, Please explain:

Name of Executive Director:
Name of Project Director:
For organization, please specify the number of:
Full Time Employees:
Part Time Employees:
Volunteers:
Planned staffing, volunteers for the project:
Full Time Employees:
Part Time Employees:
Volunteers:
What percentages of operating revenue are derived from:
Government Funding:
Grants:
FundRaising:
Investment Income:
Membership Dues:
Other :

if Other, Please explain:

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