APPLICATION COVER SHEET send to:The Linden Foundation c/o Grants Management Associates 77 Summer Street, Eighth Floor Boston, MA 02110-1006 Date: Name Of Organization: Address: Phone: IRS Tax Identification Number: CEO/Executive Director: Signature of CEO/Executive Director: Contact for this proposal: (if different) Phone: (if different) Fiscal agent: (if applicant is not a 501 (c)3 organization: Application for: (specify amount) Total budget of proposed project: ----------------------------------------------------------------------- Please respond briefly, as some readers receive the cover sheet only. A more detailed description, of up to 3 pages, should be included in the narrative: Brief description of proposed project: Please summarize project objectives: (what will be accomplished?) [OVERVIEW OF ORGANIZATION] Describe current services provided by the organization: Geographical area served: Year Founded: # Of Paid Staff: (specify f/t and p/t) # Of Members: [[FINANCIAL SUMMARY] Provide information from the most recent audit or annual financial statement Last fiscal year (FY) ended date: Last FY total expenditure: Last FY total income: *if operating surplus or loss more than 5 per cent of total income, please comment: Operating fund balance at end of last FY (from audit/financial statement): Current (projected) FY Operating Budget: [SOURCES OF SUPPORT - LAST YEAR] Please list the dollar amount received and per cent of your total support for each of the following: Governments grants and contracts: Program fees/sales and third party payments: Endowment/interest income: Other earned income: Benefits/special events (includes Corporate Sponsors): Membership: United Way: Contributions - Businesses: Contributions - Individuals: Contributions - Foundations, etc.: TOTAL: Reminder: Please review the guidelines to make sure you have included all information required. Thank you!