Peoria Diamond Club

Grant Request Application________________ Proposal No: ___

(For Grants in excess of $100) (PDC use only)

Thank you for your interest in the Peoria Diamond Club Grants Program. Since it's inception
in 1994, we have gifted thousands of dollars to various youth organizations.

As we continue to grow, so do the number and size of grant requests. To assist us in handling
the process, we have developed this Grants Request Application.

Please take a moment to review all the material enclosed. Be sure that your request proposal
is complete prior to submittal. If you feel that a specific item does not apply to your group,
please explain in as much detail as possible. No request will be declined based on an incomplete
application, however the more detail you provide, the better we may evaluate your need.
If your grant request is approved, you will need to provide receipts, or vendor verification
as requested.

Organization: _____________________________________ Grant Amount Requested: __________

Purpose of Request: __________________________________________________________________

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1. Identified Target Population: (i.e., who will benefit from this grant?)

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2. Defined Service Area (i.e. targeted school district, neighborhood, community, etc.)

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3. Describe the purpose/request as it relates to the Peoria Diamond Club Grants

Request. (refer to enclosed PDC Grants 0verview)

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4. Describe how the purpose/request works or will work. List key measurable goals
and objectives.

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5. Identify other funding sources for this purpose / request, include individuals
and organizations that contribute to the success of this request. Do not include
funders or in-kind contributors.

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6. If requested, would you make a presentation to the Grants Committee or Executive
board about your organization and request? YES or NO

7. Has this Group/Organization ever applied or received funds from the Peoria
Diamond Club? ______

(If yes, include Date, Amount and purpose of previous request)

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8. (Did you provide: (circle one)

Completed Application & Cover Sheet? YES No N/A

Letter signed by CEO/Director?. YES NO N/A

Projected budget? YES NO N/A

IRS 501{c)(3) & 509(a) status current YES No N/A

Copy of latest financial statements YES NO N/A

If you answered NO or N/A above, please explain

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